A new class in mood disorders?

Still pushing the boundaries of research

Now in his 89^th year, Professor Angst continued to enhance the understanding of bipolar I disorder with a challenging, thorough and very positively received talk on the proposed concept of “unipolar mania” as a “necessary diagnostic concept”.

DSM-5 and then some

Professor Angst was part of the early committee who helped design the DSM-5 diagnostic criteria. He firmly believes that bipolar I disorders exist as a broad spectrum of mania, with depression as a core feature. However, he believes there is a small but significant class of patients who lie beyond the current DSM-5 spectrum – those who display so-called “unipolar mania” He presented several from around the world in support of this theory.

A class apart

“Unipolar mania” is relatively uncommon, with two separate epidemiological studies of community subjects reporting an incidence of less than 2%.^1,2 Patients with “unipolar mania” present with different clinical characteristics to typical bipolar I disorder patients, with an earlier onset, fewer episodes, lower comorbidities, better long-term adjustment and more psychotic features, among other differentiating factors.³

Citing an (astonishing) 50-year epidemiology study, he showed evidence that this putative patient class were significantly longer lived than bipolar I patients: in a cohort of 403 patients followed between 1959 and 2009, mortality in the “unipolar mania” group was 76.7% vs. 89.2% in bipolar-I patients.⁴ This difference, the Professor postulated, was a result of the lower frequency of suicide and different patterns of substance abuse among this patient class.⁴

Keeping a future focus

Professor Angst concluded his talk by, in general, speaking positively about the DSM-5 scale but warning against complacency. He encouraged delegates to continue their own research into the diagnosis and treatment of patients with mood disorders – especially into the little-researched field covered in today’s address.