title: More inclusive bipolar mixed depression definitions by requiring fewer non-overlapping mood elevation symptoms.
abstract: Assess strengths and limitations of mixed bipolar depression definitions made more inclusive than that of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) by requiring fewer than three 'non-overlapping' mood elevation symptoms (NOMES).
  
  
  
  Among bipolar disorder (BD) out-patients assessed with Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation, we assessed prevalence, demographics, and clinical correlates of mixed vs. pure depression, using less inclusive (≥3 NOMES, DSM-5), more inclusive (≥2 NOMES), and most inclusive (≥1 NOMES) definitions.
  
  
  
  Among 153 depressed BD, compared to less inclusive DSM-5 threshold, our more and most inclusive thresholds, yielded approximately two- and five-fold higher mixed depression rates (7.2%, 15.0%, and 34.6% respectively), and important statistically significant clinical correlates for mixed compared to pure depression (e.g. more lifetime anxiety disorder comorbidity, more current irritability), which were not significant using the DSM-5 threshold.
  
  
  
  Further studies assessing strengths and limitations of more inclusive mixed depression definitions are warranted, including assessing the extent to which enhanced statistical power vs. other factors contributes to more vs. less inclusive mixed bipolar depression thresholds having more statistically significant clinical correlates, and whether 'overlapping' mood elevation symptoms should be counted.
authors.affiliation: Department of Psychiatry, Seoul Paik Hospital, Inje University School of Medicine, Seoul, South Korea.
authors.forename: W
authors.initials: W
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, South Korea.
authors.forename: H
authors.initials: H
authors.lastname: Kim
authors.affiliation: New York Medical College, Valhalla, NY, USA.
authors.forename: L
authors.initials: L
authors.lastname: Citrome
authors.affiliation: International Mood Centre, University of California and Veterans Administration Hospital, San Diego, CA, USA.
authors.forename: H S
authors.initials: HS
authors.lastname: Akiskal
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Goffin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Miller
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Holtzman
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: F
authors.initials: F
authors.lastname: Hooshmand
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: P W
authors.initials: PW
authors.lastname: Wang
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Hill
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Ketter
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D011595:Psychomotor Agitation / Q000523:psychology; D055815:Young Adult
keywords: bipolar disorder; depression; diagnosis; nosology; psychopathology