Professor, Psychological Medicine,Newcastle University,UKandVisiting Professor,Institute of Psychiatry, Psychology and Neuroscience,UKandDepartment of Mental Health,NTNU,Norway and Brain and Mind Centre,The University of Sydney,Australia.
Professor, Clinical Psychology,Centre for Mental Health, Swinburne University of Technology,Australia.
Br J Psychiatry. 2018 Nov;213(5):627-629. doi: 10.1192/bjp.2018.189.
The DSM-5 definition of bipolar disorder elevates increased activity or energy as a cardinal symptom (alongside mood changes) for mania and hypomania ('hypo/mania'). The ICD-10 likewise requires increases in activity and energy (alongside mood) for hypo/mania, as well as decreases for bipolar depression. Using bipolar disorder as an example, we propose that, when diagnostic criteria are revised, instruments used to measure clinical course and treatment response may need revisiting. Here, we highlight that the 'gold-standard' symptom rating scales for hypo/mania and depression were developed in an era when abnormalities of mood were viewed as the cardinal symptom of bipolar disorder. We contend that archetypal measures fail to give proportionate weighting to activity or energy, undermining their utility in monitoring bipolar disorder and treatment response in clinical and research practice.Declarations of interestJ.S. and G.M. are members of mMARCH, (Motor Activity Research Consortium for Health), which is led by Dr Kathleen Merikangas, National Institute for Mental Health. J.S. reports being a visiting professor at Diderot University, the Norwegian University of Science and Technology, Swinburne University of Technology and The University of Sydney; receiving grant funding from the UK Medical Research Council and from the UK Research for Patient Benefit programme; and receiving a personal fee from Janssen-Cilag for a non-promotional talk on sleep problems.
DSM-5 对双相情感障碍的定义将活动或能量增加作为躁狂症和轻躁狂（“轻躁狂/躁狂”）的主要症状（与情绪变化一起）。ICD-10 同样要求轻躁狂/躁狂时活动和能量增加（与情绪一起），以及双相情感障碍抑郁时减少。以双相情感障碍为例，我们提出，当诊断标准修订时，用于测量临床病程和治疗反应的工具可能需要重新审视。在这里，我们强调，轻躁狂/躁狂和抑郁的“金标准”症状评定量表是在将情绪异常视为双相情感障碍主要症状的时代开发的。我们认为，典型的测量方法没有给活动或能量适当的权重，从而削弱了它们在监测双相情感障碍和治疗反应方面的实用性，无论是在临床实践还是研究实践中。利益声明 J.S. 和 G.M. 是 mMARCH（健康运动研究联盟）的成员，该联盟由美国国立精神卫生研究院的 Kathleen Merikangas 博士领导。J.S. 报告说他是迪德罗大学、挪威科技大学、斯威本科技大学和悉尼大学的客座教授；从英国医学研究理事会和英国患者受益研究计划获得资助；并因有关睡眠问题的非促销演讲从杨森制药公司获得个人费用。
