reference bookWe hear a great deal about the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, version IV (DSM-IV) and revision DSM-V which is due to be released in May 2013. What we tend to hear less about in the United States are the World Health Organization’s ICD-10 Classification of Mental and Behavioural Disorders and any sort of official treatment guidelines.

In this post, I highlight some of the differences between DSM and ICD and let you know where you can find treatment guidelines for bipolar disorder published in the US and UK, so you can check them out for yourself.

Comparing DSM and ICD

The big difference between DSM and ICD is that ICD does not use the classifications Bipolar I, Bipolar II, Cyclothymic Disorder, or Bipolar Disorder Not Otherwise Specified (NOS), which is called Bipolar Disorder Not Elsewhere Classified (NEC) in DSM-V. Instead, ICD has a single classification called Bipolar Affective Disorder which it breaks down into subgroups based on symptoms of the current episode:

  • Bipolar affective disorder, current episode hypomanic
  • Bipolar affective disorder, current episode manic without psychotic symptoms
  • Bipolar affective disorder, current episode manic with psychotic symptoms
    • With mood-congruent psychotic symptoms
    • With mood-incongruent psychotic symptoms
  • Bipolar affective disorder, current episode mild or moderate depression
    • Without somatic syndrome
    • With somatic syndrome
  • Bipolar affective disorder, current episode severe depression without psychotic symptoms
  • Bipolar affective disorder, current episode severe depression with psychotic symptoms
    • With mood-congruent psychotic symptoms
    • With mood-incongruent psychotic symptoms
  • Bipolar affective disorder, current episode mixed
  • Bipolar affective disorder, currently in remission
  • Other bipolar affective disorders
  • Bipolar affective disorder, unspecified

DSM is similar in that in addition to the Bipolar Disorder I, II, NOS, and Cyclothymic categories, it provides diagnostic criteria for subcategories where relevant. For example, the section on Bipolar I Disorder lists separate diagnostic criteria for the following:

  • Diagnostic Criteria for Bipolar I Disorder, Single Manic Episode
  • Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Hypomanic
  • Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Manic
  • Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Mixed
  • Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Depressed
  • Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Unspecified

According to DSM-IV, the APA and WHO work closely together to ensure consistency between DSM and ICD:

Those preparing ICD-10 and DSM-IV have worked closely to coordinate their efforts, resulting in much mutual influence. ICD-10 consists of an official coding system and other related clinical research documents and instruments. The codes and term provided in DSM-IV are fully compatible with both ICD-9-CM and ICD-10. … The many consultations between the developers of DSM-IV and ICD-10 (which were facilitated by NIMH, NIDA, and NIAAA) were enormously useful in increasing the congruence and reducing meaningless differences in wording between the two systems.

Finding Bipolar Treatment Guidelines in the US and UK

In both the US and UK, you can find treatment guidelines for bipolar disorder, and in both countries, the recommended treatment guidelines vary based on the current episode a person is experiencing. In other words, treatment depends on whether a person is experiencing acute mania or hypomania, depression, psychoses, and so on.

Bipolar Treatment Guidelines in the US

The American Psychiatric Association’s bipolar treatment guidelines available online are relatively old (2002) and do not reflect the latest research in treatment options:

From 2001 to 2007, the National Institute of Mental Health (NIMH) conducted a study entitled “Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)” — a long-term study of the effectiveness of current treatments for bipolar disorder including medications and psychosocial therapies. Evidence from this and other studies have influenced the way we approach the treatment of bipolar disorder, but have not, as yet, been reflected in any official publication of treatment guidelines.

Bipolar Treatment Guidelines in the UK

In the UK, the National Institute for Health and Clinical Excellence’s (NICE) published its guide to The management of bipolar disorder in adults, children and adolescents, in primary and secondary care (or check out its Quick Reference Guide). These guidelines were published in 2006.

Although the NICE treatment guidelines are similar to the APA’s guidelines, the NICE publications are more detailed and presented in a more accessible format, complete with decision tree flow charts and quick reference tables of important items to monitor in the ongoing treatment with different medications.

Share Your Insights

We would like to know what you think. Check out the guidelines published by the APA or its Quick Reference Guide and compare it to the NICE guidelines or Quick Reference Guide. Which do you find most useful?

Reference book photo available from Shutterstock.

 







    Last reviewed: 9 Feb 2012

APA Reference
Fink, C. (2012). Guidelines for the Diagnosis and Treatment of Bipolar Disorder in the US and UK. Psych Central. Retrieved on August 22, 2014, from http://blogs.psychcentral.com/bipolar/2012/02/bipolar-diagnosis-treatment-guidelines-us-uk-dsm-icd/

 

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Candida Fink, M.D. and Joe Kraynak are authors of
Bipolar Disorder for Dummies.


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