Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-27T07:33:27.659Z Has data issue: false hasContentIssue false

Chapter 4 - The Mood Spectrum Concept: Clinical Implications

Published online by Cambridge University Press:  16 May 2024

By
Rebecca Strawbridge  and
Anthony J. Cleare
Edited by
Allan Young ,
Marsal Sanches ,
Jair C. Soares  and
Mario Juruena
Allan Young
Affiliation:
Institute of Psychiatry, King's College London
Marsal Sanches
Affiliation:
Baylor College of Medicine, Texas
Jair C. Soares
Affiliation:
McGovern Medical School, The University of Texas
Mario Juruena
Affiliation:
King's College London
Get access

Summary

Many decades have passed since the first conceptualisation of a bipolar continuum. Despite fair agreement that bipolar is not a discrete construct, there remains no universally agreed model as to how best to conceptualise a bipolar spectrum, with outstanding challenges including how and where to demarcate thresholds within it. The lack of universal consensus as to what does, and does not, constitute a bipolar spectrum disorder is a clear clinical challenge. Arguments persist as to the benefits and pitfalls of broadening the current diagnostic criteria, but it remains the case that there is still an underdiagnosis of bipolar disorders and that people meeting various subthreshold criteria share many characteristics with people who have diagnosable bipolar disorders. The evidence base for treating people with cyclothymia, depression with mixed features, and other presentations in the “gap” between formal bipolar and unipolar conditions is scant and calls for future substantial, high-quality trials.

Keywords

bipolar spectrumcyclothymiasoft bipolarsubthreshold maniatemperamentmixed features
Type
Chapter
Information
Clinical Textbook of Mood Disorders , pp. 45 - 53
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kretschmer, E. Körperbau und Charakter. Untersuchungen zum Konstitutions-Problem und zur Lehre von den Temperamenten. [Physique and character. Investigations on the constitution problem and on the doctrine of the temperaments]. Oxford: Springer, 1936: 243 p.Google Scholar
Akiskal, HS, Pinto, O. The evolving bipolar spectrum. Prototypes I, II, III, and IV. Psychiatr Clin North Am. 1999 Sep;22(3):517–34, vii.CrossRefGoogle ScholarPubMed
Angst, J. The course of affective disorders. II. Typology of bipolar manic-depressive illness. Arch Psychiatr Nervenkr. 1978 Oct 9;226(1):65–73.CrossRefGoogle ScholarPubMed
Grunze, A, Born, C, Fredskild, MU, Grunze, H. How does adding the DSM-5 criterion increased energy/activity for mania change the bipolar landscape? Front Psychiatry. 2021;12:123.CrossRefGoogle ScholarPubMed
Faurholt-Jepsen, M, Christensen, EM, Frost, M, et al. Hypomania/Mania by DSM-5 definition based on daily smartphone-based patient-reported assessments. J Affect Disord. 2020 Mar 1;264:272–8.CrossRefGoogle ScholarPubMed
Gordon-Smith, K, Jones, LA, Forty, L, Craddock, N, Jones, I. Changes to the diagnostic criteria for bipolar disorder in DSM-5 make little difference to lifetime diagnosis: findings from the U.K. Bipolar Disorder Research Network (BDRN) study. Am J Psychiatry. 2017 Aug 1;174(8):803.CrossRefGoogle Scholar
Severus, E, Bauer, M. Diagnosing bipolar disorders in DSM-5. Int J Bipolar Disord. 2013 Aug 23;1(1):14.CrossRefGoogle ScholarPubMed
Angst, J. Bipolar disorders in DSM-5: strengths, problems and perspectives. Int J Bipolar Disord. 2013 Aug 23;1(1):12.CrossRefGoogle ScholarPubMed
Angst, J, Azorin, JM, Bowden, CL, et al. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study. Arch Gen Psychiatry. 2011 Aug;68(8):791–8.CrossRefGoogle Scholar
Parker, G, Graham, R, Synnott, H, Anderson, J. Is the DSM-5 duration criterion valid for the definition of hypomania? J Affect Disord. 2014 Mar;156:87–91.CrossRefGoogle ScholarPubMed
Severus, E, Bauer, M. Diagnosing bipolar disorders: ICD-11 and beyond. Int J Bipolar Disord. 2020 Jan 20;8(1):4.CrossRefGoogle ScholarPubMed
Angst, J, Ajdacic-Gross, V, Rössler, W. Bipolar disorders in ICD-11: current status and strengths. Int J Bipolar Disord. 2020 Jan 20;8(1):3.CrossRefGoogle ScholarPubMed
Kaltenboeck, A, Winkler, D, Kasper, S. Bipolar and related disorders in DSM-5 and ICD-10. CNS Spectr. 2016 Aug;21(4):318–23.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Bowden, CL, et al. Evidence-based definitions of bipolar-I and bipolar-II disorders among 5,635 patients with major depressive episodes in the Bridge Study: validity and comorbidity. Eur Arch Psychiatry Clin Neurosci. 2013 Dec;263(8):663–73.CrossRefGoogle Scholar
ANGST, J. Problems in the current concepts and definitions of bipolar disorders. World Psychiatry. 2011 Oct;10(3):191–2.CrossRefGoogle ScholarPubMed
Taylor, RH, Ulrichsen, A, Young, AH, Strawbridge, R. Affective lability as a prospective predictor of subsequent bipolar disorder diagnosis: a systematic review. Int J Bipolar Disord. 2021 Nov 1;9(1):33.CrossRefGoogle ScholarPubMed
Li, CT, Bai, YM, Huang, YL, et al. Association between antidepressant resistance in unipolar depression and subsequent bipolar disorder: cohort study. Br J Psychiatry J Ment Sci. 2012 Jan;200(1):45–51.CrossRefGoogle ScholarPubMed
Carpenter, WT. Anticipating DSM-V: should psychosis risk become a diagnostic class? Schizophr Bull. 2009 Sep 1;35(5):841–3.CrossRefGoogle ScholarPubMed
Zachar, P, First, MB, Kendler, KS. The DSM-5 proposal for attenuated psychosis syndrome: a history. Psychol Med. 2020 Apr;50(6):920–6.CrossRefGoogle ScholarPubMed
Strakowski, SM, Fleck, DE, Maj, M. Broadening the diagnosis of bipolar disorder: benefits vs. risks. World Psychiatry. 2011;10(3):181–6.CrossRefGoogle ScholarPubMed
Vazquez, GH, Kahn, C, Schiavo, CE, et al. Bipolar disorders and affective temperaments: a national family study testing the ‘endophenotype’ and ‘subaffective’ theses using the TEMPS-A Buenos Aires. J Affect Disord. 2008 May;108(1–2):25–32.CrossRefGoogle ScholarPubMed
Paris, J. Differential diagnosis of bipolar and borderline personality disorders. Neuropsychiatry. 2011 Jun;1(3):251–7.CrossRefGoogle Scholar
Akiskal, HS, Mallya, G. Criteria for the ‘soft’ bipolar spectrum: treatment implications. Psychopharmacol Bull. 1987;23(1):68–73.Google ScholarPubMed
Ghaemi, SN, Ko, JY, Goodwin, FK. ‘Cade’s disease’ and beyond: misdiagnosis, antidepressant use, and a proposed definition for bipolar spectrum disorder. Can J Psychiatry Rev Can Psychiatr. 2002 Mar;47(2):125–34.Google Scholar
Muzina, DJ. Bipolar spectrum disorder: differential diagnosis and treatment. Prim Care Clin Off Pract. 2007 Sep 1;34(3):521–50.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Benazzi, F, et al. Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord. 2003 Jan;73(1–2):133–46.CrossRefGoogle Scholar
Phelps, J, Angst, J, Katzow, J, Sadler, J. Validity and utility of bipolar spectrum models. Bipolar Disord. 2008 Feb;10(1 Pt 2):179–93.CrossRefGoogle ScholarPubMed
Strawbridge, R, Alexander, L, Richardson, T, Young, A, Cleare, A. Is there a ‘bipolar iceberg’ in UK primary care psychological therapy services? Psycol Med. 2023 Sep;53(12):5385–94.Google Scholar
Strawbridge, R, McCrone, P, Ulrichsen, A, et al. Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study. Eur Psychiatry. 2022 Jun 15;65(1):1–21.Google ScholarPubMed
Merikangas, KR, Akiskal, HS, Angst, J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2007 May 1;64(5):543–52.CrossRefGoogle ScholarPubMed
Hantouche, EG, Akiskal, HS, Lancrenon, S, et al. Systematic clinical methodology for validating bipolar-II disorder: data in mid-stream from a French national multi-site study (EPIDEP). J Affect Disord. 1998 Sep;50(2–3):163–73.CrossRefGoogle ScholarPubMed
Hirschfeld, RMA, Cass, AR, Holt, DCL, Carlson, CA. Screening for bipolar disorder in patients treated for depression in a family medicine clinic. J Am Board Fam Pract. 2005 Jul 1;18(4):233–9.CrossRefGoogle Scholar
Smith, DJ, Griffiths, E, Kelly, M, et al. Unrecognised bipolar disorder in primary care patients with depression. Br J Psychiatry J Ment Sci. 2011 Jul;199(1):49–56.CrossRefGoogle ScholarPubMed
Zimmermann, P, Brückl, T, Nocon, A, et al. Heterogeneity of DSM-IV major depressive disorder as a consequence of subthreshold bipolarity. Arch Gen Psychiatry. 2009 Dec 1;66(12):1341–52.CrossRefGoogle ScholarPubMed
Angst, J, Cui, L, Swendsen, J, et al. Major depressive disorder with subthreshold bipolarity in the National Comorbidity Survey Replication. Am J Psychiatry. 2010 Oct 1;167(10):1194–201.CrossRefGoogle ScholarPubMed
Freedman, R, Lewis, DA, Michels, R, et al. The initial field trials of DSM-5: new blooms and old thorns. Am J Psychiatry. 2013 Jan 1;170(1):1–5.CrossRefGoogle ScholarPubMed
Youngstrom, EA, Egerton, GA, Genzlinger, J, et al. Improving the global identification of bipolar spectrum disorders: meta-analysis of the diagnostic accuracy of checklists. Psychol Bull. 2018 Mar;144(3):315–42.CrossRefGoogle ScholarPubMed
Angst, J, Adolfsson, R, Benazzi, F, et al. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord. 2005 Oct;88(2):217–33.CrossRefGoogle ScholarPubMed
Hirschfeld, RM, Williams, JB, Spitzer, RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000 Nov;157(11):1873–5.CrossRefGoogle ScholarPubMed
Nassir Ghaemi, S, Miller, CJ, Berv, DA, et al. Sensitivity and specificity of a new bipolar spectrum diagnostic scale. J Affect Disord. 2005 Feb;84(2–3):273–7.CrossRefGoogle ScholarPubMed
Bauer, MS, Crits-Christoph, P, Ball, WA, et al. Independent assessment of manic and depressive symptoms by self-rating: scale characteristics and implications for the study of mania. Arch Gen Psychiatry. 1991 Sep 1;48(9):807–12.CrossRefGoogle Scholar
Wang, YY, Xu, DD, Liu, R, et al. Comparison of the screening ability between the 32-item Hypomania Checklist (HCL-32) and the Mood Disorder Questionnaire (MDQ) for bipolar disorder: a meta-analysis and systematic review. Psychiatry Res. 2019 Mar;273:461–6.CrossRefGoogle ScholarPubMed
Ratheesh, A, Cotton, SM, Betts, JK, et al. Prospective progression from high-prevalence disorders to bipolar disorder: exploring characteristics of pre-illness stages. J Affect Disord. 2015 Sep 1;183:45–8.CrossRefGoogle ScholarPubMed
Aiken, CB, Weisler, RH, Sachs, GS. The Bipolarity Index: a clinician-rated measure of diagnostic confidence. J Affect Disord. 2015 May 15;177:59–64.CrossRefGoogle ScholarPubMed
Hede, V, Favre, S, Aubry, JM, Richard-Lepouriel, H. Bipolar spectrum disorder: what evidence for pharmacological treatment? A systematic review. Psychiatry Res. 2019 Dec 1;282:112627.CrossRefGoogle ScholarPubMed
Bielecki, JE, Gupta, V. Cyclothymic disorder. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 May 31]. Available from: www.ncbi.nlm.nih.gov/books/NBK557877/Google Scholar
Perugi, G, Hantouche, E, Vannucchi, G. Diagnosis and treatment of cyclothymia: the ‘primacy’ of temperament. Curr Neuropharmacol. 2017 Apr;15(3):372–9.CrossRefGoogle ScholarPubMed
Shim, IH, Bahk, WM, Woo, YS, Yoon, BH. Pharmacological treatment of major depressive episodes with mixed features: a systematic review. Clin Psychopharmacol Neurosci. 2018 Nov;16(4):376–82.CrossRefGoogle ScholarPubMed
Stahl, SM, Laredo, S, Morrissette, DA. Cariprazine as a treatment across the bipolar I spectrum from depression to mania: mechanism of action and review of clinical data. Ther Adv Psychopharmacol. 2020 Jan 1;10:2045125320905752.CrossRefGoogle ScholarPubMed
McKeown, L, Taylor, RW, Day, E, et al. Patient perspectives of lithium and quetiapine augmentation treatment in treatment-resistant depression: a qualitative assessment. J Psychopharmacol. 2022 May;36(5):557–65.CrossRefGoogle ScholarPubMed
Miklowitz, DJ, Semple, RJ, Hauser, M, et al. Mindfulness-based cognitive therapy for perinatal women with depression or bipolar spectrum disorder. Cogn Ther Res. 2015 Oct;39(5):590–600.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×