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

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journal contribution
posted on 2010-08-01, 00:00 authored by Michael BerkMichael Berk, F Ng, Seetal DoddSeetal Dodd, J Goldberg, G Malhi
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 interepisode 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.

History

Journal

Psychiatry and clinical neurosciences

Volume

64

Issue

4

Pagination

367 - 371

Publisher

Wiley - Blackwell Publishing Asia

Location

Richmond, Vic.

ISSN

1323-1316

eISSN

1440-1819

Language

eng

Publication classification

C1.1 Refereed article in a scholarly journal

Copyright notice

2010, The Authors