The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders

Tohen, Mauricio; Frank, Ellen; Bowden, Charles L.; Colom, Francesc; Ghaemi, S. Nassir; Yatham, Lakshmi N.; Malhi, Gin S; Calabrese, Joseph R.; Nolen, Willem A.; Vieta, Eduard; Kapczinski, Flávio; Goodwin, Guy M.; Suppes, Trisha; Sachs, Gary S.; Chengappa, K. N. Roy; Grunze, Heinz; Mitchell, Philip B.; Kanba, Shigenobu; Berk, Michael

doi:10.1111/j.1399-5618.2009.00726.x

Cited by 415 publications

(341 citation statements)

References 86 publications

(129 reference statements)

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“…23 While the construct of "recovery" from episodes of mood disorder has often been defined based mainly, if not solely, on the basis of affective symptom resolution sustained for at least 8 weeks, 21,28 a more rigorous definition of "recovery" that incorporates the absence of functional impairment was proposed over 30 years ago in the Research Diagnostic Criteria. 29 However, rigorous definitions of "recovery" that incorporate both symptomatic remission and functional improvement as indicators of treatment success have been used in only a handful of outcome studies (e.g., the National Institute of Mental Health Collaborative Depression Study) by Solomon et al 30 and Loebel et al 23 Judd et al 31 proposed a definition of major depressive episode recovery as an 8-week period free of all symptoms associated with the previous major depressive episode (asymptomatic recovery).…”

Section: Discussionmentioning

confidence: 99%

“…While both symptomatic and functional improvement are important components of full recovery, 21,23,[35][36][37][38][39][40] and may be linked, as demonstrated in several studies, 23,[35][36][37][38] they are not necessarily always coincident. 21,23,[35][36][37][40][41][42][43] The observation that functional recovery often lags behind symptomatic or syndromal recovery 41 may account for this lack of coincidence in the components of recovery.…”

Section: Madrs <= 12 Andmentioning

confidence: 99%

“…21,23,[35][36][37][40][41][42][43] The observation that functional recovery often lags behind symptomatic or syndromal recovery 41 may account for this lack of coincidence in the components of recovery. Findings from this analysis indicated that there was a moderately high level of concordance between symptomatic remission and functional remission at the endpoints of both the core (77.9%) and extension (65.9%) studies.…”

Section: Madrs <= 12 Andmentioning

confidence: 99%

“…20 Symptomatic remission and reduction in functional impairment is considered necessary for meaningful recovery from psychiatric disorders. [21][22][23] A recent study evaluated recovery in bipolar depression based on rates of combined symptomatic and functional remission sustained over time. 23 A majority of patients with bipolar depression initially treated with lurasidone in the acute phase attained recovery status during the 6-month continuation study, and treatment with lurasidone (vs. placebo) earlier in the course of a bipolar depressive episode increased the likelihood of subsequent recovery.…”

Section: Introductionmentioning

confidence: 99%

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Remission and recovery associated with lurasidone in the treatment of major depressive disorder with subthreshold hypomanic symptoms (mixed features): post-hoc analysis of a randomized, placebo-controlled study with longer-term extension

Goldberg

Ng-Mak

Siu³

et al. 2017

CNS Spectr.

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Objective. This post-hoc analysis assessed rates of symptomatic and functional remission, as well as recovery (combination of symptomatic and functional remission), in patients treated with lurasidone for major depressive disorder (MDD) associated with subthreshold hypomanic symptoms (mixed features).Method. Patients with MDD plus two or three manic symptoms (defined as per the DSM-5 mixed-features specifier) were randomly assigned to flexible-dose lurasidone 20-60 mg/day (n = 109) or placebo (n = 100) for 6 weeks, followed by a 3-month open-label, flexible-dose extension study for U.S. sites only (n = 48). Cross-sectional recovery was defined as the presence of both symptomatic remission (Montgomery-Åsberg Depression Rating Scale score ≤ 12) and functional remission (all Sheehan Disability Scale [SDS] domain scores ≤ 3) at week 6, and at both months 1 and 3 of the extension study ("sustained recovery").Results. A significantly higher proportion of lurasidone-treated patients (31.3%) achieved recovery (assessed crosssectionally) compared to placebo (12.2%, p = 0.002) at week 6. The number of manic symptoms at baseline moderated the effect size for attaining cross-sectional recovery for lurasidone treatment (vs. placebo) (p = 0.028). Sustained recovery rates were higher in patients initially treated with lurasidone (20.8%) versus placebo (12.5%).Conclusions. In this post-hoc analysis of a placebo-controlled study with open-label extension that involved patients with MDD and mixed features, lurasidone was found to significantly improve the rate of recovery at 6 weeks (vs. placebo) that was sustained at month 3 of the extension study. The presence of two (as opposed to three) manic symptoms moderated recovery at the acute study endpoint.

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Section: Discussionmentioning

confidence: 99%

Section: Madrs <= 12 Andmentioning

confidence: 99%

Section: Madrs <= 12 Andmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Remission and recovery associated with lurasidone in the treatment of major depressive disorder with subthreshold hypomanic symptoms (mixed features): post-hoc analysis of a randomized, placebo-controlled study with longer-term extension

Goldberg

Ng-Mak

Siu³

et al. 2017

CNS Spectr.

View full text Add to dashboard Cite

show abstract

“…The International Society for Bipolar Disorders (ISBD) Task Force has reported that the most commonly used definition of remission in bipolar mania is a YMRS score < 12; remission has been further operationalised as a CGI‐Bipolar Disorder Scale severity score ≤ 2 (borderline ill) for both mania and depression 14. In our post hoc category shift analyses, significantly more cariprazine‐treated patients than placebo‐treated patients with bipolar disorder shifted to borderline ill (CGI‐S = 2) or normal (CGI‐S = 1), which would suggest that these patients reached symptomatic remission with treatment.…”

Section: Discussionmentioning

confidence: 99%

Global improvement with cariprazine in the treatment of bipolar I disorder and schizophrenia: A pooled post hoc analysis

Durgam

Earley

et al. 2017

Int J Clin Pract

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SummaryIntroductionGlobal rating scale measures are useful for assessing the clinical relevance of patient change. Cariprazine, a dopamine D3 and D2 receptor partial agonist, is FDA‐approved for the adult treatment of acute manic/mixed episodes of bipolar I disorder and schizophrenia. Post hoc evaluations of Clinical Global Impressions‐Severity (CGI‐S) scores from the cariprazine pivotal trials in both indications were conducted.MethodsData from 3 bipolar mania and 3 schizophrenia trials were pooled by indication (bipolar disorder = 1033; schizophrenia = 1466). Cariprazine‐ and placebo‐treated patients were categorised by baseline CGI‐S scores; the proportion of patients who improved from more severe categories at baseline to less severe categories at end‐point was evaluated using a logistic regression model. Correlations between Young Mania Rating Scale and Positive and Negative Syndrome Scale total score changes and category shifts were also evaluated.ResultsIn both disease states, more cariprazine‐ than placebo‐treated patients had improved CGI‐S scores at end‐point; more placebo‐treated patients had worse end‐point scores. More cariprazine‐ vs placebo‐treated patients shifted from the extremely/severely ill to mildly ill/better category (bipolar disorder = 55% vs 36%, odds ratio [OR] = 2.1; P = .09; schizophrenia = 42% vs 18%, OR = 3.4, P<.01). ORs was statistically significant in favour of cariprazine in shifts from marked and moderate illness to borderline/normal in both indications (P < .05). Correlations between rating scale improvement and category shift were greatest in patients with extreme/severe baseline illness for bipolar disorder (−0.853) and schizophrenia (−0.677).ConclusionsPost hoc analyses showed that more cariprazine‐ than placebo‐treated patients with bipolar mania or schizophrenia had statistically significant and clinically meaningful CGI‐S improvement.

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Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative

Merikangas¹,

Jin²,

He³

et al. 2011

Arch Gen Psychiatry

2,110

1,351

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Context There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methodology. Objective To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder in the WHO World Mental Health survey (WMH) initiative. Design Cross-sectional face-to-face household surveys Participants 61,392 community adults in 11 countries in the Americas, Europe, and Asia Main Outcome Measure DSM-IV disorders, severity, and treatment assessed with the World Mental Health version of the WHO Composite International Diagnostic Interview (WMH CIDI 3.0), a fully-structured lay-administered psychiatric diagnostic interview. Results The aggregate lifetime prevalence of BP-I disorder was 0.6%, BP-II was 0.4%, subthreshold BP was 1.4%, and Bipolar Spectrum (BPS) was 2.4%. Twelve-month prevalence of BP-I disorder was 0.4%, BP-II was 0.3%, subthreshold BP was 0.8%, and BPS was 1.5%. Severity of both manic and depressive symptoms, and suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across bipolar subtypes. Symptom severity was greater for depressive than manic episodes, with approximately 75% of respondents with depression and 50% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least one other disorder, with anxiety disorders, particularly panic attacks, being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries where only 25% reported contact with the mental health system. Conclusions Despite cross-site variation in the prevalence rates of bipolar spectrum disorder, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior and comorbidity across each diagnostic category provide evidence for the validity of the concept of a bipolar spectrum. BPS treatment needs are often unmet, particularly in low-income countries.

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The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders

Cited by 415 publications

References 86 publications

Remission and recovery associated with lurasidone in the treatment of major depressive disorder with subthreshold hypomanic symptoms (mixed features): post-hoc analysis of a randomized, placebo-controlled study with longer-term extension

Remission and recovery associated with lurasidone in the treatment of major depressive disorder with subthreshold hypomanic symptoms (mixed features): post-hoc analysis of a randomized, placebo-controlled study with longer-term extension

Global improvement with cariprazine in the treatment of bipolar I disorder and schizophrenia: A pooled post hoc analysis

Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative

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