Validity of the assessment of bipolar spectrum disorders in the WHO CIDI 3.0

Abstract

Objective-Although growing interest exists in the bipolar spectrum, fully structured diagnostic interviews might not accurately assess bipolar spectrum disorders. A validity study was carried out for diagnoses of threshold and sub-threshold bipolar disorders (BPD) based on the WHO Composite International Diagnostic Interview (CIDI) in the National Comorbidity Survey Replication (NCS-R). CIDI BPD screening scales were also evaluated.Method-The NCS-R is a nationally representative US household population survey (n = 9282 using CIDI to assess DSM-IV disorders. CIDI diagnoses were evaluated in blinded clinical reappraisal interviews using the non-patient version of the Structured Clinical Interview for DSM-IV (SCID).Results-Excellent CIDI-SCID concordance was found for lifetime BP-I (AUC = .99 κ = .88, PPV = .79, NPV = 1.0), either BP-II or sub-threshold BPD (AUC = .96, κ = .88, PPV = .85, NPV = .99), and overall bipolar spectrum disorders (i.e., BP-I/II or sub-threshold BPD; AUC = .99, κ = .94, PPV = .88, NPV = 1.0). Concordance was lower for BP-II (AUC = .83, κ = .50, PPV = .41, NPV = .99) and sub-threshold BPD (AUC = .73, κ = .51, PPV = .58, NPV = .99). The CIDI was unbiased compared to the SCID, yielding a lifetime bipolar spectrum disorders prevalence estimate of 4.4%. Brief CIDI-based screening scales detected 67-96% of true cases with positive predictive value of 31-52%.Limitation-CIDI prevalence estimates are still probably conservative, though, but might be improved with future CIDI revisions based on new methodological studies with a clinical assessment more sensitive than the SCID to sub-threshold BPD.Conclusions-Bipolar spectrum disorders are much more prevalent that previously realized. The CIDI is capable of generating conservative diagnoses of both threshold and sub-threshold BPD. Short CIDI-based scales are useful screens for BPD.Address comments to RC Kessler, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115. ; Email: kessler@hcp.med.harvard.edu.. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Although the estimated lifetime prevalence of bipolar disorders (BPD) in international adult population surveys using structured diagnostic interviews and standardized diagnostic criteria is only approximately 0.8% for BP-I and 1.1% for BP-II, (Bauer and Pfennig, 2005;Pini et al., 2005;Waraich et al., 2004;Angst, 2004;Tohen and Angst, 2002;Wittchen et al., 2003;Weissman et al., 1996) recent clinical and epidemiological studies suggest that bipolar spectrum disorders might affect up to 6% of the general population (...

Family-based association of FKBP5 in bipolar disorder

“…1 Family, twin and adoption studies have established a substantial genetic contribution, with heritability estimates averaging about 70%. 2 The high heritability has provided a strong rationale for molecular genetic studies.…”

Correlation between the Efficacy of Lamotrigine and the Serum Lamotrigine Level during the Remission Phase of Acute Bipolar II Depression: A Naturalistic and Unblinded Prospective Pilot Study

“…According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR), the lifetime community prevalence of bipolar II disorder is 0.5%, but recent studies have reported lifetime prevalence rates of around 1.5-2%. [1][2][3][4] The course of the illness is characterized by recurrent episodes of hypomania and depression interspersed with periods of euthymia. Patients are symptomatic for >50% of the time, with depression of varying severity being the most common symptom.…”

Classification of Mental Disorders Based on Temperament

“…Mood disorders have diverse and sometimes paradoxical definitions. Hagop Akiskal defines bipolar disorders along a spectrum that comprises eight types (1)(2)(3)(4). The fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders (DSM-5)" and the 10th revision of "The International Classification of Diseases (ICD 10)" provide somewhat different definitions of these disorders.…”