Do we need to flick the switch? The need for a broader conceptualization of iatrogenic course aggravation in clinical trials of bipolar disorder

Authors: Berk, Michael; Ng, Felicity; Dodd, Seetal; Goldberg, Joseph F.; Malhi, Gin S.

Source: Psychiatry and Clinical Neurosciences, Volume 64, Number 4, 1 August 2010 , pp. 367-371(5)

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Abstract:

The term `switching' is often used in bipolar disorder when describing polarity changes in bipolar disorder, but this term is ambiguous and imprecise, and is sometimes used interchangeably with the term `cycling'. Furthermore, polarity changes in bipolar disorder can be understood in different ways, because their clinical manifestations range from the emergence of subthreshold symptoms to a full episode of the opposite pole. Besides the need to tighten the meaning of the term `switching', this paper also argues that switching does not adequately describe the complex phenomena that occur with course aggravation of bipolar disorder, such as alteration in episode frequency or amplitude. A more-fine grained approach to course aggravation in bipolar disorder is proposed, which incorporates trans-polar switching, index polarity aggravation, as well as alterations in episodic amplitude, episodic duration, and inter-episode length. This approach has the potential to capture a broader, more fine-grained and clinically relevant picture of the process of aggravation of the bipolar cycle.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1440-1819.2010.02098.x

Affiliations: 1: Mount Sinai School of Medicine and Affective Disorders Research Program, Silver Hill Hospital, New York, USA

Publication date: 2010-08-01