DSM-5 criteria

1. For this Module, you may cite the DSM-5 as one of your references, as I ask below about DSM-5 criteria. Many of you will mention the Ghaemi video, please cite it if you do, but you still must cite 3 non-video references in your post.

2. You have been presented a variety of perspectives on the topic of Bipolar Disorder. As a reminder, Allen Frances noted that the DSM-IV made it much easier to get a diagnosis of bipolar disorder (Links to an external site.), creating what some have called a “diagnostic epidemic.” This was true not just for children, but to some degree for adults. Healy and LeNoury focused on the problem (Links to an external site.) of skyrocketing diagnoses of childhood bipolar in the mid-2000s, but their article also raises many problems about the adult diagnosis of bipolar, including drug company marketing and loosening of criteria as compared to DSM-III. The issue of comorbid substance abuse diagnosis was raised in this module. Finally, Nassir Ghaemi argued in his lecture that under-identification of bipolar disorder is a real problem, and you read a discussion of differential diagnosis and bipolar disorder authored by psychiatrists.

After going through all this material, what conclusions do you come to regarding bipolar disorder- is under-diagnosis or over-diagnosis the problem? Healy argues that overdiagnosis and overtreatment of of Bipolar can have devastating consequences, Ghaemi argues that missing Bipolar Disorder can have tragic consequences.

Who is right? Focus mainly on adults in your answer. How does the issue of hypomania fit into your answer? Are the requirements for hypomania (in term of time/duration and symptoms) clearly distinguishable as a psychiatric syndrome? What do you make of the fact that hypomania by the DSM-5 definition must be “not severe enough to caused marked impairment in social or occupational functioning”? In general, do you see the DSM-5 criteria as setting a reasonable scientific boundary between “normal” distress and bipolar II disorder? Both illicit drugs (stimulants) and prescribed psychiatric drugs (stimulants, SSRIs) can create a hypomanic state – is this adequately addressed in the DSM criteria? What do you make of the Healy’s claim that many clients who are diagnosed as bipolar now would have received other diagnoses in past decades?

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