ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Article - 20 years of the Zurich Study: lessons for screening and understanding the bipolar spectrum


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ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Article - 20 years of the Zurich Study: lessons for screening and understanding the bipolar spectrum

Vol 1 - Iss 2 - Article - 20 years of the Zurich Study: lessons for screening and understanding the bipolar spectrum #10

20 years of the Zurich Study: lessons for screening and understanding the bipolar spectrum Jules Angst1, Alex Gamma1, Elie Hantouche2, Franco Benazzi3, Vladeta Ajdacic1, Dominique Eich1 and Wulf Rössler1 1 Zurich University Psychiatric Hospital, 2 Mood Center, Pitié-Salpêtrière Hospital, Paris, France, 3 E. Hecker Outpatient Psychiatry Centre, Ravenna, and Department of Psychiatry, National Health Service, Forli, Italy. Correspondence and requests for reprints should be addressed to: Dr. Jules Angst, M.D. Mail Box 1931, CH-8032 Zurich Email: jangst@bli.unizh.ch Abstract Background: There is wide concern about an over-diagnosis of depression at the expense of bipolar disorders. Two major sources of their under-recognition are the difficulties in the assessment of hypomania and the definition of a diagnostic specifier for bipolar depressive syndromes. Methodology: In the Zurich cohort study mood disorders were assessed six times (from age 20 to 41) in 591 persons (representing a cohort of 2600 persons of the same age) by clinical psychologists and psychiatrists; the attrition rate after 20 years was 38.5%. The assessment of depressive and hypomanic symptoms was to a certain extent independent of the current diagnostic manuals. Three definitions of bipolar-II disorder were applied and compared to major depressive disorder (MDD). Results: For case definitions, apart from the number of symptoms, both duration and frequency of episodes of depression were shown to be clinically relevant. In the case of hypomania recurrence was contributing to clinical relevance even more than duration. A two-factor structure of hypomanic symptoms was replicated. The three definitions of BP-II disorder formed a spectrum with a gradient of characteristics for bipolarity from DSM-IV via Zurich strict and broad criteria (2 or more of 7 criterial symptoms of mania/hypomania) to MDD. Discussion: Assessing overactivity (instead of euphoria and irritability) as a stem question for hypomania identified a large group of depressives with hypomanic symptoms. On the basis of clinical validators new definitions for major and minor uni- and bipolar depressive syndromes are proposed. Broad Zurich criteria are clinical indicators of bipolarity and characterise a large BP-II group that differs from MDD. Limitations and conclusions: Today’s classification of major and minor bipolar disorders is unsatisfactory. More epidemiological data, collected independently of the assumptions of the diagnostic manuals, are desirable. Key Words: bipolar spectrum, screening, prevalence, diagnosis Download the Article for FREE

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