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Cited by 85Bipolar Disorder and TreatmentMental Health Research TopicsSchizophrenia research and treatment

The empirical redefinition of the psychometric criteria for remission in bipolar disorder

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Berk, Michael, Ng, Felicity, Wang, Wei V., Calabrese, Joseph R., Mitchell, Philip B., Malhi, Gin S., Tohen, Mauricio·2008·Journal of Affective Disorders
DOI 10.1016/j.jad.2007.06.011
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Abstract

Background Current definitions of remission for mania and bipolar depression are convention-rather than empirically-based, and their clinical salience is unclear, as few studies have attempted to calibrate them against objective clinical criteria. This study aimed to determine equivalence scores on two widely used clinical rating scales, the Young Mania Rating Scale (YMRS) and Montgomery-Asberg Depression Rating Scale (MADRS), that corresponded with an objective global clinical measure of remission in bipolar disorder patients.Methods Data from four pharmacological randomised controlled trials in bipolar I disorder were analysed. Two trials were conducted for bipolar depression (N=410 and 833), and two for manic or mixed episodes (N=136 and 110). In this study, a Clinical Global Impression-Bipolar Version (CGI-BP) severity score of 1 (normal, not at all ill) was used as the primary comparative measure of remission. The mean total YMRS and MADRS scores in the mania and depression studies, respectively, that corresponded with a CGI-BP severity score of 1 were determined.Results The mean YMRS score that corresponded with a CGI-BP severity score of 1 was <4 in both trials (2.6 and 3.0, respectively), and the mean corresponding MADRS score was <5 (4.1 and 4.6, respectively).Limitations Utilising a psychometric definition of remission.Conclusions This study suggests that a cut-off score of <5 on the MADRS and <4 on the YMRS approximates a CGI-BP definition of complete remission. Although lower than conventional cut-off scores, these perhaps better represent clinical reality and patient expectations. In the context of clinical trials, study end-points may be more difficult to reach with lower cut-offs, but the outcomes achieved are more likely to be clinically meaningful.

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  • Even a score of 7 on the Hamilton Depression Rating Scale may not reflect true remission.

    “Even a score of 7 on the HDRS, for example, may not reflect true remission [54], and it has been suggested that lower scores (<5) correlate with objective cutoff points.”

    From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [54]

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Authors
Berk, M., Ng, F., Wang, W. V., Calabrese, J. R., Mitchell, P. B., Malhi, G. S., & Tohen, M.
Affiliations
  • Barwon Health (AU)
  • Case Western Reserve University (US)
  • Black Dog Institute (AU)
  • The University of Sydney (AU)
  • McLean Hospital (US)
Corresponding author
Ng, Felicity
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2008-02
Volume
106
Issue
1-2
Pages
153-158
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2007.06.011
OpenAlex
W2132515561
Cited by
85
References
22
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 9 · 2021: 2 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 4 · 2016: 8 · 2015: 3 · 2014: 3 · 2013: 7 · 2012: 4
FWCI
4.02
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Funders
Eli Lilly and Company
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
bipolar disorder, remission, mania, bipolar depression, Young Mania Rating Scale, Montgomery-Asberg Depression Rating Scale, clinical trial endpoints, bipolar I disorder
MeSH terms
Olanzapine, Lamotrigine, Benzodiazepines, Bipolar Disorder, Double-Blind Method, Drug Therapy, Combination, Fluoxetine, Follow-Up Studies, Humans, Personality Assessment, Psychiatric Status Rating Scales, Psychometrics, Antipsychotic Agents, Triazines, Reproducibility of Results, Randomized Controlled Trials as Topic, Treatment Outcome, Antimanic Agents

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