Abstract
‘Bipolar depression is not a specific type of depression, with most episodes phenotypically weighted to melancholic or psychotic depression. In order to improve our understanding of the etiology and management of bipolar depression, sub-typing heterogeneity should be constrained. A ‘top-down’ approach to delineate specific sub-typing characteristics is suggested, allowing consideration as to whether ‘bipolar depression’ differs in expression across bipolar I (BPD I) and II (BPD II) disorders. Current diagnostic systems employ imprecise criteria to differentiate sub-types of BPD, disallowing ‘top-down’ studies seeking to identify prototypical bipolar depression features.
We describe a categorical ‘isomer’ model, assisting discrimination between bipolar subtypes and unipolar depressive disorders. In essence, the respective presence or absence of psychotic features differentiates BPD I from BPD II, with a core elevated mood/energy construct delineating BPD from unipolar disorders. Our model allows a ‘top-down’ approach to clinical diagnosis, versus the questionable validity of the bipolar spectrum ‘soft signs’ approach.
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© 2009 Birkhäuser Verlag/Switzerland
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Parker, G.B., Fletcher, K. (2009). The clinical diagnosis of bipolar depression. In: Zarate, C.A., Manji, H.K. (eds) Bipolar Depression: Molecular Neurobiology, Clinical Diagnosis and Pharmacotherapy. Milestones in Drug Therapy. Birkhäuser Basel. https://doi.org/10.1007/978-3-7643-8567-5_2
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DOI: https://doi.org/10.1007/978-3-7643-8567-5_2
Publisher Name: Birkhäuser Basel
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Online ISBN: 978-3-7643-8567-5
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