School of Psychiatry - University of New South Wales and Black Dog Institute, Randwick, NSW, Australia.
Department of Psychiatry, University of Calgary, Calgary, AB, Canada.
Aust N Z J Psychiatry. 2018 Dec;52(12):1173-1182. doi: 10.1177/0004867418808382. Epub 2018 Oct 31.
To derive new criteria sets for defining manic and hypomanic episodes (and thus for defining the bipolar I and II disorders), an international Task Force was assembled and termed AREDOC reflecting its role of Assessment, Revision and Evaluation of DSM and other Operational Criteria. This paper reports on the first phase of its deliberations and interim criteria recommendations.
The first stage of the process consisted of reviewing , and recent International Classification of Diseases criteria, identifying their limitations and generating modified criteria sets for further in-depth consideration. Task Force members responded to recommendations for modifying criteria and from these the most problematic issues were identified.
Principal issues focussed on by Task Force members were how best to differentiate mania and hypomania, how to judge 'impairment' (both in and of itself and allowing that functioning may sometimes improve during hypomanic episodes) and concern that rejecting some criteria (e.g. an imposed duration period) might risk false-positive diagnoses of the bipolar disorders.
This first-stage report summarises the clinical opinions of international experts in the diagnosis and management of the bipolar disorders, allowing readers to contemplate diagnostic parameters that may influence their clinical decisions. The findings meaningfully inform subsequent Task Force stages (involving a further commentary stage followed by an empirical study) that are expected to generate improved symptom criteria for diagnosing the bipolar I and II disorders with greater precision and to clarify whether they differ dimensionally or categorically.
为了制定新的躁狂和轻躁狂发作的标准（从而定义双相 I 型和 II 型障碍），一个国际工作组成立，并被称为 AREDOC，反映了其在 DSM 和其他操作性标准评估、修订和评估方面的作用。本文报告了其审议的第一阶段和临时标准建议。
该过程的第一阶段包括审查和最近的国际疾病分类标准，确定其局限性，并制定修改后的标准集，以进一步深入考虑。工作组的成员对修改标准的建议作出了回应，并从这些建议中确定了最具问题的问题。
工作组成员关注的主要问题是如何最好地区分躁狂和轻躁狂，如何判断“损害”（本身及其功能有时可能在轻躁狂发作期间改善），以及担心拒绝某些标准（例如，规定的持续时间）可能会导致双相障碍的假阳性诊断。
本第一阶段报告总结了国际双相障碍诊断和管理专家的临床意见，使读者能够思考可能影响其临床决策的诊断参数。这些发现为随后的工作组阶段（包括进一步的评论阶段和随后的实证研究）提供了有意义的信息，预计这些阶段将为更准确地诊断双相 I 型和 II 型障碍制定更好的症状标准，并澄清它们是否在维度或类别上有所不同。
