By Gordon Parker
Reports our wisdom of Bipolar II disease, masking its historical past, category, neurobiology and treatment.
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Extra resources for Bipolar II disorder : modelling, measuring and managing
How many such soft signs, or sub-threshold features of hypomania, are sufficient to warrant a change in diagnostic presumptions? We have almost no data on which to base an answer to this question. In one recent post hoc analysis, Frye et al. (2006) have reported that even the most minimal hypomanic symptoms, and far short of the DSM diagnostic threshold, predict a doubling of antidepressantassociated switching into hypomania/mania. However, these patients had 24 James Phelps previously been diagnosed as having bipolar disorder and were receiving mood stabiliser treatment.
C D E 17 The bipolar spectrum With the advent of the DSM–IV in 1994, Point D was formally recognised as ‘bipolar’. Again presuming proper differential diagnosis, a patient with depression who also clearly has a history of symptoms meeting DSM criteria for hypomania would be given a diagnosis of BP II. Yet this system has always been vulnerable to questions of degree: what about patients at Point C, or even Point B? e. non-manic features associated with subsequent manic or hypomanic episodes) warrant consideration as at least ‘not unipolar’.
And it isn’t that we’re infallible, either; it’s just that we are able to approach it more as a continuous issue, rather than as a black-and-white, yes-no. How many such soft signs, or sub-threshold features of hypomania, are sufficient to warrant a change in diagnostic presumptions? We have almost no data on which to base an answer to this question. In one recent post hoc analysis, Frye et al. (2006) have reported that even the most minimal hypomanic symptoms, and far short of the DSM diagnostic threshold, predict a doubling of antidepressantassociated switching into hypomania/mania.