DOI: 10.1097/01.yic.0000423276.88854.36

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Issn Print: 0268-1315

Publication Date: 2012/12/01


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The upcoming DSM-5: changes for bipolar II disorder and minor bipolar disorder

O Pinto

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In the middle of next year it will be published the 5th edition of DSM. The main attention was geared towards the changes affecting hypomania criteria, because the increase in the prevalence of bipolar diagnosis needed a more realistic approach to this phase of the illness.
In regards of cyclothymia, it is certain that no changes will take place. This central temperament, crucial for the understanding of most Bipolar II or Spectrum diagnosis, continues like it is today: totally forgotten and not being paid attention whatsoever.
Again, the central question remained the concept of true hypomania in regards to the importance of activation and energy, both crucial for the diagnosis, and also the number of days of duration of the episodes. Also very important are the recognition of mixed depressive episodes and mixed hypomanias.
Activation and energy will be added to the diagnosis of hypomania as part of the criteria A, but in a useless way because it will be like this: Elevated or irritable mood AND Activation or increased energy. As everybody could see the word AND and not OR make the diagnosis even harder to be made because, in totally useless manner, is in the criterion A and is no longer belonging in the criterion B, In summation: energy and activation will be downplayed in importance as part of hypomanic episodes.
Changes for the number of minimal days necessary to make the diagnosis of hypomania are even more disappointing with the support of studies like Jules Angst BRIDGE STUDY, clearly showing that even 1 day captures this phase of bipolar II, and others, the number of days of hypomania will stay the same, four days.
Mixed depression and mixed hypomanias will, for the first time in the DSM system, appear in classification as specifiers in the NOS (not elsewhere specified) category.
Again, in a very non logical way, these specifiers will be allowed to be applied to Major Depression. To be quite clear: patients will be allowed to have hypomanic episodes and remain Unipolars.
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