2 - The bipolar spectrum  pp. 15-45

The bipolar spectrum

By James Phelps

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An experienced host prepares to serve a ceremonial fowl. The guests look on with anticipation. The knife is sharpened. After he identifies the gap between thigh and body, the carving proceeds neatly. This image is often invoked in discussions of diagnostic systems, speaking of ‘carving nature at its joints’. But what if the entity in question does not have joints? This is the essence of the bipolar spectrum perspective.

Most diagnostic systems – and many clinicians – categorise illnesses as discrete entities. This monograph has a similar orientation. In focusing on Bipolar II Disorder (BP II), it assumes that this is a distinct condition or entity and able to be distinguished from other putatively categorical mood disorders (particularly Bipolar I Disorder (BP I) and unipolar depression). But what if BP II is not an entity but rather a point on a continuous spectrum of mood disorders? This chapter examines such a proposition.

At least eight recent reviews have been written on the bipolar spectrum concept – including a chapter by the chairman of the International Society for Bipolar Disorder (ISBD) Diagnostic Guidelines Task Force (Ghaemi et al., 2006); and a review with recommendations for changes to the DSM–IV, prepared for that Task Force by this author and colleagues (Phelps et al., 2007); as well as six other cogent overviews (Katzow et al., 2003; Dunner, 2003; Moller and Curtis, 2004; Angst and Cassano, 2005; Mondimore, 2005; Skeppar and Adolfsson, 2006).

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Angst, J. and Cassano, G. (2005). The mood spectrum: improving the diagnosis of bipolar disorder. Bipolar Disorders, 7 (Suppl. 4), S4–12.
Angst, J., Gamma, A., Benazzi, F. et al. (2003). Toward a re-definition of sub-threshold bipolarity: epidemiology and proposed criteria for Bipolar-II, minor bipolar disorders and hypomania. Journal of Affective Disorders, 73, 133–46.
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Dunner, D. L. (2003). Clinical consequences of under-recognized bipolar spectrum disorder. Bipolar Disorders, 5, 456–63.
El-Mallakh, R. S. and Ghaemi, S. N. (2006). Bipolar Depression. Washington, DC: American Psychiatric Publishing.
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El-Mallakh, R. S. and Karippot, A. (2005). Antidepressant-associated chronic irritable dysphoria (acid) in bipolar disorder: A case series. Journal of Affective Disorders, 84, 267–72.
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Ghaemi, S. N., Daversa, C., Bauer, M. et al. (2006). Summary of the International Society for Bipolar Disorders Diagnostic Guidelines Task Force Report. Bipolar Disorders, in review.
Ghaemi, S. N., Ko, J. Y. and Goodwin, F. K. (2002). ‘Cade's disease’ and beyond: Misdiagnosis, antidepressant use, and a proposed definition for Bipolar Spectrum Disorder. Canadian Journal of Psychiatry, 47, 125–34.
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Katzow, J. J., Hsu, D. J. and Ghaemi, S. N. (2003). The bipolar spectrum: a clinical perspective. Bipolar Disorders, 5, 436–42.
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Mondimore, F. M. (2005). Unipolar depression/bipolar depression: connections and controversies. International Review of Psychiatry, 17, 39–47.
Parker, G., Tully, L., Olley, A. and Hadzi-Pavlovic, D. (2006). SSRIs as mood stabilizers for Bipolar II Disorder? A proof of concept study. Journal of Affective Disorders, 92, 205–14.
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Phelps, J. (2006). Why Am I Still Depressed? Recognising and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorders. New York: McGraw-Hill.
Phelps, J. R. (2005b). Agitated dysphoria after late-onset loss of response to antidepressants: a case report. Journal of Affective Disorders, 86, 277–80.
Phelps, J. R. and Ghaemi, S. N. (2006). Improving the diagnosis of bipolar disorder: predictive value of screening tests. Journal of Affective Disorders, 92, 141–8.
Phelps, J. R., Angst, J., Katzow, J. and Sadler, J. (2006). Validity and utility of the Bipolar Spectrum. Bipolar Disorders, in review.
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