APADevelopmentalApproachesBipolarDisorder - 2010 American...

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© 2010 American Psychiatric Association. All Rights Reserved. See for more information. 1 Issues Pertinent to a Developmental Approach to Bipolar Disorder in DSM-5 Over the past ten years, considerable discussion has focused on the appropriate diagnostic criteria for bipolar disorder (BD) in children and adolescents. While similar discussions have occurred concerning the diagnosis in adults, in some instances, the intensity of the questions are greater for youth than adults. The questions that have arisen are both complex and numerous. After detailed consideration by the Childhood and Adolescent Disorders and the Mood Disorders Work Groups, the two work groups are jointly recommending that three actions be taken to more clearly define the boundaries of BD across the developmental spectrum. Of note, extensive discussions in both the Childhood and Adolescent Disorders and Mood Disorders Work Groups grappled with questions regarding appropriate diagnostic criteria in all age groups, and both work groups recognize the importance of developmental perspectives. Therefore, the actions articulated in the current document are designed, in general, to facilitate more precise diagnosis and more targeted treatment for BD across the lifespan. The current document reflects a consensus view of the Childhood and Adolescent Disorders and the Mood Disorders Work Groups, based on discussions within each work group as well as liaison discussions between the groups. 1. Revise the wording of the criteria for manic and hypomanic episodes in order to operationalize episodicity more clearly. A. Specific changes being recommended: 1. Add “and present most of the day, nearly every day” to the A criterion 2. Add “and represent a noticeable change from usual behavior” to the stem language for the B criteria. B. Rationale : From its earliest descriptions and throughout all iterations of the DSM, BD has been described as an episodic illness. Indeed, in both the DSM-IV and in the proposed criteria for DSM-5, clinicians cannot make a diagnosis of BD until they have explicitly confirmed the presence of a hypomanic or manic episode . However, the question of what constitutes an episode has been the subject of some controversy and confusion, especially in the child psychiatry literature. In the view of the Mood Disorders Work Group, the wording of the DSM-IV criteria for mania and hypomania may have contributed to that confusion. The proposed change is therefore a clarification (level 1) whose goal would be to ensure that diagnostic practices remain consistent with both the intention of previous iterations of the DSM and across the developmental spectrum. Consistency in diagnostic practices across the developmental spectrum is
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This note was uploaded on 04/12/2010 for the course PSY 339 taught by Professor Neal during the Spring '09 term at University of Texas at Austin.

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APADevelopmentalApproachesBipolarDisorder - 2010 American...

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