Clinical research diagnostic criteria for bipolar illness (CRDC-BP): rationale and validity

Abstract

Background In the 1970 s, scientific research on psychiatric nosology was summarized in Research Diagnostic Criteria (RDC), based solely on empirical data, an important source for the third revision of the official nomenclature of the American Psychiatric Association in 1980, the Diagnostic and Statistical Manual, Third Edition (DSM-III). The intervening years, especially with the fourth edition in 1994, saw a shift to a more overtly “pragmatic” approach to diagnostic definitions, which were constructed for many purposes, with research evidence being only one consideration. The latest editions have been criticized as failing to be useful for research. Biological and clinical research rests on the validity of diagnostic definitions that are supported by firm empirical foundations, but critics note that DSM criteria have failed to prioritize research data in favor of “pragmatic” considerations. Results Based on prior work of the International Society for Bipolar Diagnostic Guidelines Task Force, we propose here Clinical Research Diagnostic Criteria for Bipolar Illness (CRDC–BP) for use in research studies, with the hope that these criteria may lead to further refinement of diagnostic definitions for other major mental illnesses in the future. New proposals are provided for mixed states, mood temperaments, and duration of episodes. Conclusions A new CRDC could provide guidance toward an empirically-based, scientific psychiatric nosology, and provide an alternative clinical diagnostic approach to the DSM system.

Characterizing the clinical profile of mania without major depressive episodes: a systematic review and meta-analysis of factors associated with unipolar mania

“…During 1960s, pioneering research highlighted that manic-depressive illness, as conceptualized by Emil Kraepelin (1856–1926), is not nosologically homogeneous, stressing the differences between the unipolar and bipolar course of affective disorders in terms of genetics, premorbid personality, and clinical outcomes (Angst & Marneros, 2001 ). Bipolar disorder (BD) is a multidimensional condition which includes a multitude of clinical subtypes (Ghaemi et al, 2022 ; McIntyre et al, 2022 ) and might be based on different neurobiological underpinnings (Han, De Berardis, Fornaro, & Kim, 2019 ; Sepede et al, 2020 ). Over the years, the diagnostic concept of unipolar mania (UM), i.e.…”

A compelling need to empirically validate bipolar depression

“…We read with great interest the paper by Ghaemi et al ( 2022 ) entitled “Clinical research diagnostic criteria for bipolar illness (CRDC-BP): rationale and validity” recently published in the International Journal of Bipolar Disorders. Essentially the authors highlight the need for “new, purely research-based diagnostic criteria aimed primarily at validity” as “essential to the success of biological and pharmacological research”.…”

The Diagnostic Concept of Unipolar Mania

“…The dimension of nonpathological affective temperaments—historically included in the “borderland” described by Akiskal (1994) and recently classified by the CRDC-BP (Ghaemi et al, 2022)—in which the opposite polarities were represented by dysthymic and hyperthymic temperaments;…”

“…Thus, although not explicitly classifying UM, they implicitly considered the possibility that it might exist. Moreover, the Clinical Research Diagnostic Criteria for Bipolar Illness (CRDC-BP) (Ghaemi et al, 2022) defined UM as the occurrence of manic or mixed manic episodes at least once in a lifetime, without any history of depressive episodes. Scientific literature reported that at least 2 or 3 manic episodes in the absence of depressive episodes, in a period of at least 4 or 5 years, are required for UM diagnosis (even if, according to even more conservative definitions, at least 4 episodes, in a considerably longer period of 10 years, would be needed) (Baek et al, 2014).…”

“…i. The dimension of nonpathological affective temperamentshistorically included in the "borderland" described by Akiskal (1994) and recently classified by the CRDC-BP (Ghaemi et al, 2022)-in which the opposite polarities were represented by dysthymic and hyperthymic temperaments; ii. The dimension of affective disorders with unipolar course, including, on one side, unipolar depression (i.e., the DSM-5-defined major or persistent depressive disorders), and on the other side, UM; and iii.…”