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Evidence for the continuous latent structure of mania and depression in out-patients with bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

Published online by Cambridge University Press:  17 April 2015

J. J. Prisciandaro  and
B. K. Tolliver
J. J. Prisciandaro*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
B. K. Tolliver
Affiliation:
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
*
* Address for correspondence: J. J. Prisciandaro, Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, PO Box 250861, Charleston, SC 29425, USA. (Email: [email protected])
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Abstract

Background

Evidence supporting the continuous latent structure of mood phenomena has not been incorporated into psychiatric diagnostic systems, in part because the evidence has been incomplete. For example, no studies have investigated the boundary between ‘sick’ and ‘well’ periods in individuals with bipolar disorder, despite agreement that characterization of mood disorders as having a discrete episodic course is inaccurate. The present study examined the validity of mood episode symptom thresholds in out-patients with bipolar disorder using multiple methodologies: taxometrics and information-theoretic latent distribution modeling (ITLDM), to evaluate the continuity/discontinuity of mood symptoms; and structural equation mixture modeling (SEMM), to evaluate the continuity/discontinuity of associations between mood symptoms and general functioning.

Method

A total of 3721 out-patients with bipolar disorder from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were available for analysis. Data were collected at participants’ baseline STEP-BD visit. Taxometric [maximum covariance/means above minus below a cut (MAXCOV/MAMBAC) with simulated comparison data], ITLDM and SEMM methods were applied twice, once to the Montgomery–Åsberg Depression Rating Scale and again to the Young Mania Rating Scale.

Results

Taxometric results unequivocally supported a continuous interpretation of the data. ITLDM results favored many valued ‘discrete metrical’ models, suggesting that mood symptoms have continuous, but potentially non-normally distributed, latent structures in out-patients with bipolar disorder. Finally, SEMM results demonstrated that latent associations between mood symptoms and general functioning were linear.

Conclusions

Results from the present study argue against the validity of DSM mood episode thresholds and argue for a graded continuum of care of bipolar symptom management.

Keywords

Bipolar disordercategorical assessmentdepressiondimensional assessmentmaniataxometrics
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 12 , September 2015 , pp. 2595 - 2603
Copyright
Copyright © Cambridge University Press 2015 

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