Objective: A significant revision in criteria related to bipolar disorder in DSM-5 has been done. This study evaluated the impact of these changes on diagnosis and reviewed the challenges that clinicians and researchers will encounter in the use and implementation of DSM-5 criteria for bipolar disorder.
Methods: The sample consisted of a total of 82 patients (50 women and 32 men) with a diagnosis of bipolar disorder according to DSMIV, with an average age of 36.9±10.8 years. All participants had been monitored in our outpatient department for at least 2 years and during that time had received a diagnosis of bipolar disorder. Their last episodes were reviewed according to DSM-5 criteria and changes in diagnosis are evaluated.
Results: When using the DSM-5 criteria, there was an increase in the number of cases diagnosed with manic episode compared to using the DSM-IV TR criteria (43 vs. 24 cases). As DSM-5 does not include a mixed episode diagnosis, a portion of the cases (69.3%) diagnosed with mixed episode according to DSM-IV TR were diagnosed with manic episode/additional feature by DSM-5, with the remaining cases 30.7% described as undefined/additional feature
Conclusion: Our results suggest that an additional 18.2% of bipolar disorder patients met the diagnostic threshold for manic episode when using DSM-5 criteria, compared to previous criteria. Clinical trials may now also need to focus on treatment effects in patient groups with or without mixed features. Medications that are efficient in treating mixed episodes defined according to DSM-IV TR may also be useful in treating mixed features as defined by DSM-5, but further studies will be required to assess this assumption.