How Can Data Guide Diagnosis? Epidemiological Data Analysis for Bipolar Disorder Diagnosis

Bipolar disorder (BD) is the 6^th leading cause of disability worldwide. There are concerns with the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) which may be addressed in the next version of the DSM. To meet criteria for a manic episode the patient must have a primary symptom (elevated, expansive or irritable mood) in addition to three or more secondary symptoms. However, currently mild mania is often misdiagnosed as major depressive disorder and this leads to inappropriate treatment such as antidepressant medication without a mood stabilizer. Studies show that increased physical activity may be a core symptom of mania. The symptom also facilitates the assessment of mild mania retrospectively, because it is easier to recall a change in activity than a change in mood. In order to examine the effect of adding increased physical activity to the diagnostic criteria, we analyzed data from the Systematic Treatment Evaluation Program for Bipolar Disorder (STEP-BD). The large multicenter effectiveness study has broad inclusion criteria in order to assure demographic diversity. Our aim was to compare the diagnostic groups with increased physical activity as a primary vs. a secondary symptom. We performed the statistical analysis using the chi-squared test and the ANOVA test to examine statistically significant relationships. We observed an increase in prevalence of BD after modifying the criteria in patients seeking care. We think that this DSM change may lead to more specific diagnosis and better treatment.