To validate the recognition efficacy of bipolar disorders (BD) and BD typeⅡ (BDⅡ) under bipolarity specifier among patients with major depressive episode (MDE).

This is a multi-site,cross-sectional diagnostic study.727 consecutive subjects with major depressive episode (MDE) were screened for BD and BDⅡunder the bipolarity specifier,the DSM-Ⅳ-TR criteria and the clinical known diagnosis criteria at 20 psychiatric hospitals between March and September 2008,to compare the BD recognition rate and analyze factors related with BD using multi-factors regression analysis.

Screened positive BD were 39.9%,14.4% and 31.9% under bipolarity specifier,DSM-Ⅳ-TR and clinical known diagnosis criteria,while screened positive BDⅡwere 30.8%,9.5% and 20.5% respectively.Compared with DSM-Ⅳ-TR,bipolarity specifier screened BD with relatively high sensitivity and specificity (100% and 70.3%); while compared with clinical known diagnosis criteria,bipolarity specifier screened BDⅡwith very good sensitivity and specificity (85.9% and 83.4%),plus relatively low under-diagnosis and over-diagnosis rate.Screened positive BD under bipolarity specifier combined with higher rate of borderline personality disorder (BPD)/anxiety disorder compared with negative ones.Multi-factors regression analysis found the OR value of two variables including switching during previous antidepressant treatment (OR=4.66) and mood episode during antidepressant treatment (OR=3.68) were relatively high under bipolarity specifier.These are also different from those under DSM-Ⅳ-TR.For the common markers under either bipolarity specifier or DSM-Ⅳ-TR,the OR value of three variables including relatives of first degree with mania/hypomania (OR=3.58),illness course with free interval (OR=2.54) and irritability during previous antidepressant treatment (OR=2.40) were relatively high,thus indicates five high risk factors of BD with all the P value<0.01.

This study initially validated well recognition efficacy of bipolarity specifier for both BD and BDⅡ among patients with MDE.The results may also help for further subset classification of BD.

Bipolar disorder; Depressive disorder; Diagnosis