THE PERFORMANCE OF DSM-III-R MAJOR DEPRESSION CRITERIA IN THE DIAGNOSIS OF BIPOLAR MIXED STATES

Two hundred thirty-seven (237) manic patients diagnosed by DSM-III-R c riteria as either purely manic (204) or mixed bipolar (33) were review ed for analysis of the diagnostic performance of the DSM-III-R criteri a required to diagnose the mixed bipolar state. We calculated the sens itivity, specificity, positive predictive value (PPV), negative predic tive value (NPV), and diagnostic efficiency of each of the 9 DSM-III-R criteria for major depression in this cohort. As predicted, four of t he major depression criteria had low diagnostic utility, with PPV's le ss than 0.3. Those items were: weight change; sleep disturbance; psych omotor change; and diminished ability to think or concentrate or indec isiveness. Four symptoms: anhedonia, fatigue, feelings of worthlessnes s or guilt, and recurrent thoughts of death or suicidal ideation had a cceptable utility for the diagnosis of mixed states. (C) 1997 Elsevier Science B.V.