Do we need to flick the switch? The need for a broader conceptualization of iatrogenic course aggravation in clinical trials of bipolar disorder
Article first published online: 10 MAY 2010
© 2010 The Authors. Journal compilation © 2010 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences
Volume 64, Issue 4, pages 367–371, August 2010
How to Cite
Berk, M., Ng, F., Dodd, S., Goldberg, J. F. and Malhi, G. S. (2010), Do we need to flick the switch? The need for a broader conceptualization of iatrogenic course aggravation in clinical trials of bipolar disorder. Psychiatry and Clinical Neurosciences, 64: 367–371. doi: 10.1111/j.1440-1819.2010.02098.x
- Issue published online: 23 JUL 2010
- Article first published online: 10 MAY 2010
- Received 29 November 2009; revised 10 March 2010; accepted 23 March 2010.
- bipolar disorder;
- clinical trial;
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 inter-episode 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.