Notice bibliographique
Résumé
Dear Editor: The review paper by Dr Patten and Dr Paris1 in the November 2008 issue of The CJP is a very important one. On one hand, a growing number of researchers have been diagnosing bipolar disorders (BDs) (bipolar spectrum) more and more, and, on the other hand, a group of researchers remark that many disorders of the bipolar spectrum lack diagnostic validation. This upward trend of bipolar diagnoses, mainly bipolar II disorder (BD-II), has reached a figure of around 50%, compared with major depressive disorder (MDD), in outpatient clinical settings. The broad boundaries of the bipolar spectrum are mainly related to: 1. better probing for hypomania (thus BD-II), overcoming the misdiagnoses of structured interviews by using semi-structured interviews carried out by clinicians, which assess all past hypomanic symptoms, especially overactivity, and bypass the stem, and skip out the question on mood change of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IY) Structured Clinical Interview for DSM-IV (SCID), a cause of missed BD-II diagnoses; 2. shorter, validated minimum duration of hypomania (1 to 3 days), as the 4-day DSM-IV minimum duration is only consensus-based; 3. inclusion of MDD with bipolar features not otherwise specified, such as bipolar family history, young age-at-onset, many recurrences, mixed depression (that is, the cooccurrence of depression and subthreshold hypomania); and 4. while SCID focuses mainly on the impairment (nonmarked) for diagnosing hypomania; most hypomania have superior functioning (reviewed by Benazzi2). The same DSM-IV-TR reports in the text that hypomania may have increase in efficiency, accomplishments, or creativity, compared with the usual behaviour, or some functional impairment. Hecker3 reported that most outpatient hypomanias have superior functioning, while Kraepelin,4 studying inpatients, reported more on the impairment of hypomania. So, a syndrome that does not meet DSM-IV criteria for a disorder (that is, distress and impairment) should still be considered a disorder? By itself, hypomania is often a pleasant period of improved functioning. However, BD-H is mainly a depressive disorder,2 and hypomania occupies a minority of the period of illness.2 Compared with MDD, BD-II is more severe (for example, more recurrences, comorbidity, suicidality, and unstable course), which makes detection of hypomania important for treatment and outcome (clinical validity).2 Beyond BD-II, MDD with bipolar features has been included in the bipolar spectrum. Its clinical utility (and need to detection) has been preliminary shown by finding that in bipolar mixed depression (mixed depression is not uncommon in MDD, too) the concurrent subsyndromal hypomanic symptoms can be worsened by antidepressants (lower response rate, more switching rate).2,5 1 fully share the view by Dr Patten and Dr Paris that the best test of the bipolar spectrum is its clinical validity. Up to now, many bipolar spectrum disorders have yet to show clear evidence of clinical validity (apart from BD-II). I would support research in this area, more to assess clinical utility than diagnostic validity (given the unknown biological underpinnings of BDs, the current validators are only a questioned proxy of validation). References 1. Patten SB, Paris J. The bipolar spectrum - a bridge too far? Can J Psychiatry. 2008;53(1 1):762-768. 2. Benazzi F. Bipolar disorder - focus on bipolar II disorder and mixed depression. Lancet. 2007;369:935-945. 3. Koukopoulos A. Ewald Hecker' s description of cyclothymia as a cyclical mood disorder: its relevance to the modern concept of bipolar II. J Affect Disord. 2003;73:199-205. 4. Kraepelin E. …
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,025 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,004 | 0,007 |
| Science ouverte | 0,004 | 0,001 |
| Intégrité de la recherche | 0,010 | 0,013 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,006 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».