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Evidence-based definitions of bipolar-I and bipolar-II disorders among 5,635 patients with major depressive episodes in the Bridge Study: validity and comorbidity

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European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

The definitions of bipolar-I (BP-I) and bipolar-II (BP-II) disorders are currently under revision by the APA and by the WHO. We provide evidence of a revised set of criteria for bipolar disorders and major depressive disorder (MDD) which could serve to strengthen the construct and predictive validity of both disorders and enable more incisive studies of treatments and courses of both disorders. In the diagnostic Bridge Study of 5,635 patients with major depressive episodes from 18 countries (Europe, North Africa, Near East and Far East) leading psychiatrists in each country assessed a pre-specified group of symptoms, illness course, family history and duration of episodes; these data allowed tests of several definitions of bipolarity. The primary revised specifier diagnosis of BP-I disorder included manic episodes based on an additional category A criterion (increased activity/energy) and did not apply any exclusion criteria. The revised BP-II disorders included hypomanic episodes of 1–3 days. Family history and illness course validators (history of mania/hypomania among first degree relatives, 2 or more lifetime episodes and first symptoms having occurred before age 30) discriminated clearly between patients with bipolar-I or bipolar-II disorders meeting bipolarity specifier criteria and those with MDD. Specifier definitions provided better discrimination between MDD and the two bipolar subgroups. Patterns of concurrent comorbidities also differed significantly between patients meeting criteria for MDD compared with those meeting bipolar specifier criteria. Comorbidity patterns differed between bipolar-I and bipolar-II patients. This study provides evidence for the validity of modified (specifier) BP-I and BP-II definitions that incorporate illness course and family history which reduce ambiguities of major depressive episodes between bipolar-I and bipolar-II disorders and MDD.

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Acknowledgments

The diagnostic Bridge Study was organised and sponsored by Sanofi-Aventis. We thank them for providing us with all data and derived variables for analyses without any restrictions.

Conflict of interest

Prof. Dr. Jules Angst has served on the advisory board for Eli Lilly & Company, Janssen Cilag, Lundbeck, on the speakers’ bureau for Eli Lilly & Company, Lundbeck AstraZeneca and Bristol-Myers Squibb, and as a consultant for Sanofi-Aventis; A.G. is a statistician of JA and has no conflict of interest to declare; C.L.B. has acted as a consultant for Pfizer, Bristol Myers Squibb, Repligen, and Merck. He has served on an advisory board of Sanofi-Aventis. He has received grant support from NIMH, Johnson and Johnson, and Bristol Myers Squibb; J.M.A. has undertaken consultancy work for Lilly, Janssen, Sanofi-Aventis, Lundbeck, Astra Zeneca, and Bristol-Myers-Squibb; and has received honoraria form Lilly, Janssen, Lundbeck, Sanofi-Aventis, Bristol-Myers-Squibb, Pfizer, and Novartis in relation to conference presentations; G.P. has acted as consultant of Sanofi-Aventis, Bristol Myers Squibb, Astra Zeneca, Eli Lilly, Boehringer Ingheleim; received grant/research support from Eli lilly, Astra Zeneca, Boehringer Ingheleim, Glaxo-SmithKline; is on the speaker/advisory board of Sanofi-Aventis, Bristol Myers Squibb, Astra Zeneca, Eli Lilly, Boehringer Ingheleim, Glaxo-SmithKline, Pfyzer, Wyeth, Jannsen-Cilag, Lundbeck; E.V. has acted as consultant, received grant/research support or honoraria from Almirall, Astra-Zeneca, Bristol-Myers-Squibb, Eli Lilly, Ferrer, Forest Research Institute, Geodon Richter, Glaxo-Smith-Kline, Janssen-Cilag, Jazz, Johnson & Johnson, Lundbeck, Merck Sharpe and Dohme, Novartis, Organon, Otsuka, Pierre-Fabre, Pfizer, Roche, Sanofi-Aventis, Servier, Shering-Plough, Shire, Takeda, United Biosource Corporation and Wyeth; A.H.Y. has acted as a consultant, received grant/research support or honoraria from, and/or has been on the advisory boards of Sanofi-Aventis, Eli-Lilly, Bristol-Myers Squibb, BCI, AstraZeneca, GSK, Janssen, Pfizer and Servier.

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Authors and Affiliations

  1. Zürich University Psychiatric Hospital, Lenggstrasse 31, P.O. Box 1931, 8032, Zurich, Switzerland

    J. Angst & A. Gamma

  2. University of Texas Health Center, San Antonio, TX, USA

    C. L. Bowden

  3. Hôpital de Sainte-Marguerite, Marseille, France

    J. M. Azorin

  4. University of Pisa, Pisa, Italy

    G. Perugi

  5. Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain

    E. Vieta

  6. Imperial College, London, UK

    A. H. Young

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  1. J. Angst
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  2. A. Gamma
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  3. C. L. Bowden
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  4. J. M. Azorin
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  5. G. Perugi
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  6. E. Vieta
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  7. A. H. Young
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Correspondence to J. Angst.

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The study was conducted for the Bridge Study Group.

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Angst, J., Gamma, A., Bowden, C.L. et al. Evidence-based definitions of bipolar-I and bipolar-II disorders among 5,635 patients with major depressive episodes in the Bridge Study: validity and comorbidity. Eur Arch Psychiatry Clin Neurosci 263, 663–673 (2013). https://doi.org/10.1007/s00406-013-0393-4

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  • DOI: https://doi.org/10.1007/s00406-013-0393-4

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