The duration of undiagnosed bipolar disorder: effect on outcomes and treatment response.

Introduction: There are commonly long delays between the onset of bipolar disorder (BP), seeking of treatment and acquiring a bipolar disorder diagnosis. Whether a longer duration of undiagnosed bipolar disorder (DUBP) leads to an inferior treatment response is unclear in the literature.

Method: We conducted two studies with independent samples of BP patients who had received a first-time diagnosis of BP - first investigating whether DUBP was related to clinical and social outcomes at the time of assessment (n=173) and, second, whether response to mood stabiliser medication was affected by DUBP when assessed three months following assessment and intervention (n=64).

Screening for bipolar disorder: does gender distort scores and case-finding estimates?

Background: Gender differences in rates of bipolar disorder have been described, with most studies reporting males as over-represented in those diagnosed with a bipolar I disorder and females over-represented in those diagnosed with a bipolar II disorder. This could reflect true differences in prevalence or measurement error emerging from screening or case-finding measures. We examine the possible contribution of the latter by examining one screening measure-the Mood Swings Questionnaire (MSQ).

Is the DSM-5 duration criterion valid for the definition of hypomania?

Background: DSM-IV and DSM-5 impose a 4 day duration criterion for hypomanic episodes yet several studies have suggested that such an imposition may be invalid. We report a study involving a large sample pursuing the likely salience of the DSM duration criterion.

Methods: We analyzed data on hypomanic symptoms provided by two bipolar screening measures - the Mood Disorders Questionnaire (MDQ) and the Mood Swings Questionnaire (MSQ) in a sample of 501 patients meeting DSM and other symptom criteria for a bipolar II disorder (BP II) and contrasted data for 186 meeting the DSM minimum duration of 4 days and 315 experiencing episodes lasting less than 4 days (i.

High-risk behaviour in hypomanic states.

Background: Risk-taking behaviours during hypomanic states are recognised, however the high-risk nature of some behaviours-including the potential for harm to both the individual and others-has not been detailed in the research literature. The current study examines risk-taking behaviours and their consequences (including their potential for impairment) in those with a bipolar II condition.

Method: Participants were recruited from the Sydney-based Black Dog Institute Depression Clinic.

Discriminating melancholic and non-melancholic depression by prototypic clinical features.

Background: Melancholia is positioned as either a more severe expression of clinical depression or as a separate entity. Support for the latter view emerges from differential causal factors and treatment responsiveness but has not been convincingly demonstrated in terms of differential clinical features. We pursue its prototypic clinical pattern to determine if this advances its delineation.

Temperament and personality in bipolar II disorder.

Background: There is limited research examining temperament and personality in bipolar II disorder. We sought to determine any over-represented temperament and personality features in bipolar II disorder compared to other affective groups.

Method: Scores on a self-report measure of temperament and personality were examined in a sample of 443 participants diagnosed with unipolar, bipolar I and bipolar II disorder.

Does testing for bimodality clarify whether the bipolar disorders are categorically or dimensionally different to unipolar depressive disorders?

Background: It has been held that if bipolar disorder is categorically distinct, it should differentiate from unipolar depressive disorders by showing bimodality or a 'zone of rarity' in bipolar symptom scores. Two previous studies have failed to demonstrate bimodality. We undertook a third study.

The impact of detecting bipolar disorder in previously diagnosed unipolar patients at a specialist depression clinic.

This study aimed to examine the short-term clinical impact of identifying bipolar disorder in patients previously managed as having a unipolar disorder. The study was incorporated within a consecutive sample of 1000 patients attending a specialist depression clinic for diagnostic and management considerations. Of those assessed, 34% were evaluated as having a bipolar disorder, with this condition having been diagnosed for the first time in three-quarters of those patients.

Inching toward Bethlehem: mapping melancholia.

Background: As melancholia has resisted symptom-based definition, this report considers possible explanations and options for moving forward. Clinician-assigned melancholic and non-melancholic groups were initially compared to refine a candidate set of differentiating symptoms alone for examination against a set of non-clinical validators. Analyses then examined the capacity of both the refined symptom and validator sets to discriminate the assigned melancholic and non-melancholic subjects.

Screening for bipolar disorder: the utility and comparative properties of the MSS and MDQ measures.

Background: Our objective was to further determine the diagnostic utility of the Mood Swings Survey (MSS) in distinguishing bipolar and unipolar disorders, and draw comparisons between this measure and the widely-used Mood Disorder Questionnaire (MDQ).

Methods: A total of 247 consecutively recruited patients attending the Black Dog Institute Depression Clinic were administered the Mood Swings Survey (MSS) as part of a computerized Mood Assessment Program (MAP), in addition to undergoing clinical assessment by two independent psychiatrists. The MDQ, along with a structured interview assessing DSM-IV criteria for bipolar disorder, was administered to a sub-sample of patients.