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The DSM-5 definition of bipolar disorder elevates increased activity or energy as a cardinal symptom (alongside mood changes) for mania and hypomania ('hypo/mania'). The ICD-10 likewise requires increases in activity and energy (alongside mood) for hypo/mania, as well as decreases for bipolar depression. Using bipolar disorder as an example, we propose that, when diagnostic criteria are revised, instruments used to measure clinical course and treatment response may need revisiting. Here, we highlight that the 'gold-standard' symptom rating scales for hypo/mania and depression were developed in an era when abnormalities of mood were viewed as the cardinal symptom of bipolar disorder. We contend that archetypal measures fail to give proportionate weighting to activity or energy, undermining their utility in monitoring bipolar disorder and treatment response in clinical and research practice.Declarations of interestJ.S. and G.M. are members of mMARCH, (Motor Activity Research Consortium for Health), which is led by Dr Kathleen Merikangas, National Institute for Mental Health. J.S. reports being a visiting professor at Diderot University, the Norwegian University of Science and Technology, Swinburne University of Technology and The University of Sydney; receiving grant funding from the UK Medical Research Council and from the UK Research for Patient Benefit programme; and receiving a personal fee from Janssen-Cilag for a non-promotional talk on sleep problems. [ABSTRACT FROM AUTHOR]

Aaron Temkin Beck (known to friends and colleagues as Tim) was born in Providence, Rhode Island, on 18 July 1921, the youngest of four children of Russian Jewish immigrants. Beck celebrated his centenary with a Zoom birthday gathering, during which he received a message from the Dalai Lama, who told Beck that 'you have lived a truly meaningful life and continue to be an inspiration to us all'. In the 1970s, Beck asked: 'Can a fledgling psychotherapy challenge the giants in the field - psychoanalysis and behaviour therapy?. [Extracted from the article]

Background The assumption that patients with bipolar disorder make a full inter-episode recovery has been challenged by limited evidence that suggests that neuropsychological dysfunction in bipolar disorder may persist beyond episodes of illness. Aims To test the hypothesis that patients with euthymic bipolar disorder show neuropsychological impairment. Method A battery of neuropsychological tests (assessed attention, working memory, learning and executive function) was administered to three matched groups of subjects: good-outcome patients with bipolar disorder (n=21); poor-outcome patients with bipolar disorder (n=20); controls (n=20). All patients were clinically euthymic, although some had low levels of depressive symptoms. Results Patients performed worse than controls on a number of neuropsychological tests. When age, premorbid IQ and depressive symptoms were controlled for, the results indicated impairment of executive function. Conclusions These findings provide good evidence for the existence of neuropsychological impairment in patients with euthymic bipolar disorder, although the possible effect of medication should not be overlooked,This may be of clinical relevance and raises questions about the course and outcome of the illness. [ABSTRACT FROM AUTHOR]

Defining chronic depression as persistent symptoms for 2 or more years, a prevalence of chronic depression of 12-15% is found in the literature. A four-part classification of chronic depression is proposed: Chronic Primary Major Depression; Chronic Secondary Major Depression; Characterological or Chronic Minor Depression (Dysthymic Disorder); and 'Double Depression'. The literature indicates several factors predicting chronicity in primary major depression: more at risk are female patients, particularly those with premorbid neurotic personality traits, individuals with unipolar disorders, and those with higher familial loading for such disorders. Other factors are the adequacy and appropriateness of the treatment given, and the length of illness episode prior to treatment being received. Larger studies with well-matched controls are needed. [ABSTRACT FROM AUTHOR]

Chronic depression is defined as "symptomatic non-recovery for a period of 2 or more years". Chronic primary major depressives (n = 24) were compared retrospectively with a control group of primary major depressives (n = 20) who had recovered from their illness episode within 2 years. The former had a significantly higher familial loading for affective disorder and showed an increased incidence of independent undesirable life events during the 6 months prior to and 2 years after the onset of their illness. Female chronic depressives also had a significantly greater number of previous illness episodes and a more frequent history of thyroid dysfunction. Personality as measured on the EPO, psychiatric problems arising as secondary complications of the depressive illness, and developmental object loss did not differentiate chronic from non-chronic depressives. [ABSTRACT FROM AUTHOR]

A response from the author of the article "Rates of voluntary and compulsory psychiatric in-patient treatment in England: an ecological study investigating associations with deprivation and demographics", that was published in the "British Journal of Psychiatry", is presented.

A letter to the editor is presented in response to comments made on the author's article about the influence of premorbid neuroticism on duration of depressive illness in the November 1992 issue.