Devenir des troubles bipolaires et place du trouble dysphorique prémenstruel dans le DSM-5

Abstract

In the field of bipolar disorders, the fifth edition of the DSM has clarified the definition of manic mood, which includes irritability and expansiveness. This elevated mood is associated with increased goal-directed activity or energy. A full manic episode that emerges during an antidepressant treatment (e.g., medication, electroconvulsive therapy) is now sufficient evidence for a manic episode diagnosis and therefore for a bipolar disorder I diagnosis. If so a mood-stabilizer treatment is required. The DSM-5 authors call for more caution in case of hypomanic episodes induced by antidepressant treatment, especially if only one or two symptoms are present. On the other hand, if there are psychotic features, the episode is, by definition, manic. Several studies have judged the bereavement exclusion criteria irrelevant to fulfil the diagnosis of major depressive episode, that is why this exclusion criteria has disappeared from DSM-5. This might help for a better management of major depressive episode in case of mourning. The lack of consensual definition of mixed state led to the suppression of the mixed episode in this new edition of the DSM. It is however possible to specify the mixed features in manic, hypomanic and depressive episodes. This decision is in coherence with Emil Kraepelin's inheritance. In fact, Kraepelin himself described several mixed states, essentially as transition states between the two main clinical pictures (mania and depression) of the manic-depressive illness. In this perspective, clinical pictures such as agitated depression, dysphoric manic or hypomanic episodes can be reconsidered and one can hope that studies will be conducted to deepen the knowledge of those episodes from a clinical, physiopathological and therapeutic point of view. Finally the premenstrual dysphoric disorder has moved from the appendix B (for the research) of the DSM-IV to the “diagnostic criteria and codes” (section II) of the DSM-5. This disorder is quite frequently associated with bipolar disorder II whose prognosis it worsens while complicating its therapeutic management. In the paper, the premenstrual dysphoric disorder is described on an historical, clinical, physiopathological and therapeutic level, within the limits of current knowledge about this uncommon psychiatric syndrome. Its DSM-5 diagnostic criteria are also summarized and commented upon. This official entry of the premenstrual dysphoric disorder in the DSM-5 shows the willingness of the American Psychiatric Association to incorporate uncommon psychiatric syndromes in its diagnostic classification.