Defining the clinical course of bipolar disorder: response, remission, relapse, recurrence, and roughening.

Robert Ma Hirschfeld, Joseph R. Calabrese, Mark A. Frye, Philip W. Lavori, Gary Sachs, Michael E. Thase, Karen Wagner

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

This manuscript presents working definitions for key clinical course indicators for bipolar disorder, including response, remission, relapse, recurrence, and roughening. A work group of experts in bipolar disorder reviewed prior efforts to define clinical course indicators for unipolar depression and for schizophrenia. Using these efforts as templates, the work group developed consensus operational definitions. The rationale for each of the definitions was a point of time when a treatment decision needed to be made. The group defined response as a 50% reduction in a score from a standard rating scale of symptomatology from an appropriate baseline, regardless of index episode type (manic, depressed, or mixed). In addition, the other pole cannot be significantly worsened during response. Remission was defined as absence or minimal symptoms of both mania and depression for at least 1 week. Sustained remission requires at least eight consecutive weeks of remission, and perhaps as many as 12 weeks. A relapse/recurrence was defined as a return to the full syndrome criteria of an episode of mania, mixed episode, or depression following a remission of any duration. Roughening was defined as a return of symptoms at a subsyndromal level, perhaps representing a prodrome of an impending episode. The work group recommends that all reports of clinical trials in bipolar disorder include results using these definitions. This will introduce standards for such reports. Hopefully, the definitions will be revised and improved over time.

Original languageEnglish (US)
Pages (from-to)7-14
Number of pages8
JournalPsychopharmacology Bulletin
Volume40
Issue number3
StatePublished - 2007
Externally publishedYes

Fingerprint

Bipolar Disorder
Recurrence
Depression
Depressive Disorder
Schizophrenia
Consensus
Clinical Trials
Therapeutics

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Hirschfeld, R. M., Calabrese, J. R., Frye, M. A., Lavori, P. W., Sachs, G., Thase, M. E., & Wagner, K. (2007). Defining the clinical course of bipolar disorder: response, remission, relapse, recurrence, and roughening. Psychopharmacology Bulletin, 40(3), 7-14.

Defining the clinical course of bipolar disorder : response, remission, relapse, recurrence, and roughening. / Hirschfeld, Robert Ma; Calabrese, Joseph R.; Frye, Mark A.; Lavori, Philip W.; Sachs, Gary; Thase, Michael E.; Wagner, Karen.

In: Psychopharmacology Bulletin, Vol. 40, No. 3, 2007, p. 7-14.

Research output: Contribution to journalArticle

Hirschfeld, RM, Calabrese, JR, Frye, MA, Lavori, PW, Sachs, G, Thase, ME & Wagner, K 2007, 'Defining the clinical course of bipolar disorder: response, remission, relapse, recurrence, and roughening.', Psychopharmacology Bulletin, vol. 40, no. 3, pp. 7-14.
Hirschfeld RM, Calabrese JR, Frye MA, Lavori PW, Sachs G, Thase ME et al. Defining the clinical course of bipolar disorder: response, remission, relapse, recurrence, and roughening. Psychopharmacology Bulletin. 2007;40(3):7-14.
Hirschfeld, Robert Ma ; Calabrese, Joseph R. ; Frye, Mark A. ; Lavori, Philip W. ; Sachs, Gary ; Thase, Michael E. ; Wagner, Karen. / Defining the clinical course of bipolar disorder : response, remission, relapse, recurrence, and roughening. In: Psychopharmacology Bulletin. 2007 ; Vol. 40, No. 3. pp. 7-14.
@article{8148fe019ed9405c8fa7fe691798c50f,
title = "Defining the clinical course of bipolar disorder: response, remission, relapse, recurrence, and roughening.",
abstract = "This manuscript presents working definitions for key clinical course indicators for bipolar disorder, including response, remission, relapse, recurrence, and roughening. A work group of experts in bipolar disorder reviewed prior efforts to define clinical course indicators for unipolar depression and for schizophrenia. Using these efforts as templates, the work group developed consensus operational definitions. The rationale for each of the definitions was a point of time when a treatment decision needed to be made. The group defined response as a 50{\%} reduction in a score from a standard rating scale of symptomatology from an appropriate baseline, regardless of index episode type (manic, depressed, or mixed). In addition, the other pole cannot be significantly worsened during response. Remission was defined as absence or minimal symptoms of both mania and depression for at least 1 week. Sustained remission requires at least eight consecutive weeks of remission, and perhaps as many as 12 weeks. A relapse/recurrence was defined as a return to the full syndrome criteria of an episode of mania, mixed episode, or depression following a remission of any duration. Roughening was defined as a return of symptoms at a subsyndromal level, perhaps representing a prodrome of an impending episode. The work group recommends that all reports of clinical trials in bipolar disorder include results using these definitions. This will introduce standards for such reports. Hopefully, the definitions will be revised and improved over time.",
author = "Hirschfeld, {Robert Ma} and Calabrese, {Joseph R.} and Frye, {Mark A.} and Lavori, {Philip W.} and Gary Sachs and Thase, {Michael E.} and Karen Wagner",
year = "2007",
language = "English (US)",
volume = "40",
pages = "7--14",
journal = "Psychopharmacology Bulletin",
issn = "0048-5764",
publisher = "MedWorks Media LLC",
number = "3",

}

TY - JOUR

T1 - Defining the clinical course of bipolar disorder

T2 - response, remission, relapse, recurrence, and roughening.

AU - Hirschfeld, Robert Ma

AU - Calabrese, Joseph R.

AU - Frye, Mark A.

AU - Lavori, Philip W.

AU - Sachs, Gary

AU - Thase, Michael E.

AU - Wagner, Karen

PY - 2007

Y1 - 2007

N2 - This manuscript presents working definitions for key clinical course indicators for bipolar disorder, including response, remission, relapse, recurrence, and roughening. A work group of experts in bipolar disorder reviewed prior efforts to define clinical course indicators for unipolar depression and for schizophrenia. Using these efforts as templates, the work group developed consensus operational definitions. The rationale for each of the definitions was a point of time when a treatment decision needed to be made. The group defined response as a 50% reduction in a score from a standard rating scale of symptomatology from an appropriate baseline, regardless of index episode type (manic, depressed, or mixed). In addition, the other pole cannot be significantly worsened during response. Remission was defined as absence or minimal symptoms of both mania and depression for at least 1 week. Sustained remission requires at least eight consecutive weeks of remission, and perhaps as many as 12 weeks. A relapse/recurrence was defined as a return to the full syndrome criteria of an episode of mania, mixed episode, or depression following a remission of any duration. Roughening was defined as a return of symptoms at a subsyndromal level, perhaps representing a prodrome of an impending episode. The work group recommends that all reports of clinical trials in bipolar disorder include results using these definitions. This will introduce standards for such reports. Hopefully, the definitions will be revised and improved over time.

AB - This manuscript presents working definitions for key clinical course indicators for bipolar disorder, including response, remission, relapse, recurrence, and roughening. A work group of experts in bipolar disorder reviewed prior efforts to define clinical course indicators for unipolar depression and for schizophrenia. Using these efforts as templates, the work group developed consensus operational definitions. The rationale for each of the definitions was a point of time when a treatment decision needed to be made. The group defined response as a 50% reduction in a score from a standard rating scale of symptomatology from an appropriate baseline, regardless of index episode type (manic, depressed, or mixed). In addition, the other pole cannot be significantly worsened during response. Remission was defined as absence or minimal symptoms of both mania and depression for at least 1 week. Sustained remission requires at least eight consecutive weeks of remission, and perhaps as many as 12 weeks. A relapse/recurrence was defined as a return to the full syndrome criteria of an episode of mania, mixed episode, or depression following a remission of any duration. Roughening was defined as a return of symptoms at a subsyndromal level, perhaps representing a prodrome of an impending episode. The work group recommends that all reports of clinical trials in bipolar disorder include results using these definitions. This will introduce standards for such reports. Hopefully, the definitions will be revised and improved over time.

UR - http://www.scopus.com/inward/record.url?scp=54349109711&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=54349109711&partnerID=8YFLogxK

M3 - Article

C2 - 18007564

AN - SCOPUS:54349109711

VL - 40

SP - 7

EP - 14

JO - Psychopharmacology Bulletin

JF - Psychopharmacology Bulletin

SN - 0048-5764

IS - 3

ER -