Bipolar disorder supplement needed broader perspective · Bipolar disorder supplement needed...

LETTERS

326 MJA • Volume 194 Number 6 • 21 March 2011

Bipolar disorder supplement needed broader perspectiveJon N Jureidini, Peter I Parry, Catherine M Houen and Malcolm W Battersby

TO THE EDITOR: The supplement of theJournal published on 16 August 2010 —“Bipolar disorder: new understandings,emerging treatments”1 — illustrates anumber of features of the current implemen-tation of the Journal’s supplement policythat are problematic. While it is clearlystated that the supplement “was supportedby an unconditional grant from AstraZenecaNeuroscience”, the amount of sponsorship,to whom it was paid, and how it was usedwere not disclosed. Such information isparticularly pertinent as evidence suggeststhat the pharmaceutical industry has finan-cial motivation to see a widening of thediagnostic boundaries of bipolar disorderand a rebadging of atypical antipsychotics as“mood stabilisers”.2

The provenance of the articles is notrevealed — it is not clear whether thearticles were solicited, part of a symposium,or from some other source. Bipolar disorderis a controversial area in psychiatry,3 yetdespite much useful information in the arti-cles in the supplement, discussion of thiscontroversy is a minor feature and no signif-icant critical appraisal is offered. To give amore balanced view to readers, it wouldhave been desirable to have included articlesthat highlight the controversy regardingbipolar II and bipolar spectrum diagnosesand discuss the ways in which personalitydisorders arising from developmental

trauma and attachment problems canpresent with mood and behavioural distur-bances that can be confused with bipolardisorder.

Competing interests: Jon Jureidini, Peter Parryand Malcolm Battersby are members of HealthySkepticism.

Jon N Jureidini, Professor of Psychiatry1

Peter I Parry, Senior Lecturer in Psychiatry2

Catherine M Houen, Psychiatrist3

Malcolm W Battersby, Professor of Psychiatry2

1 University of Adelaide, Adelaide, SA.2 Flinders University, Adelaide, SA.3 Flinders Medical Centre, Adelaide, SA.peter.parry@health.sa.gov.au

1 Castle DJ, Berk M, Hocking BM. Bipolar disorder:new understandings, emerging treatments. Med JAust 2010; 193 (4 Suppl): S3-S4.

2 Spielmans GI, Parry PI. From evidence-based medi-cine to marketing-based medicine: the evidencefrom internal industry documents. J Bioeth Inq2010; 7: 13-29.

3 Paris J. The bipolar spectrum: a critical perspective.Harv Rev Psychiatry 2009; 17: 206-213. ❏

David J Castle, Michael Berk and Barbara M Hocking

IN REPLY: Jureidini and colleagues raiselegitimate issues pertinent to our MedicalJournal of Australia supplement on bipolardisorders, and we are pleased to respond.First, the extent of sponsorship from Astra-Zeneca was for publication only. One of us(D J C) discussed the idea of the supplementwith the Editor of the Journal, and Astra-Zeneca expressed interest in supporting theproject. Neither the Journal editors nor anyof the supplement authors were involved inthe sponsorship negotiations between Astra-Zeneca and the publisher of the Journal, andneither received any financial or other assist-ance or reimbursement from AstraZeneca.Second, as Coordinating Editors of the sup-plement, we determined the content of thesupplement without any input from Astra-Zeneca, and we directly solicited articlesfrom leading experts of our choice in appro-priate fields. All articles were subject to theusual review process accorded all publica-tions in the Journal.

Regarding the general issue of the bound-aries of the bipolar concept, we are verymuch aware of the ongoing debate. This is apervasive issue for a discipline devoid ofbiological markers that can be used to definea plane of cleavage. Indeed, we highlightedthis in the second paragraph of our editorialas an “immediate area of controversy”. Wealso solicited the article by Tiller and Sch-weitzer specifically to address the diagnostic

problems in the area of mood instability; inthat article, there is specific mention of boththe bipolar spectrum and mood instabilityin the so-called personality disorders.2

With respect, Jureidini and colleaguesfall into a common trap by considering thatthe use of some atypical antipsychotics inbipolar disorder is a rebadging exercise.This is silliness. One could equally arguethat sodium valproate, carbamazepine andlamotrigine are not legitimate mood stabi-lisers but, rather, rebadged anticonvul-sants. Tricyclic antidepressants started lifeas antihistamines. What matters to us asclinicians and researchers is that peoplewith bipolar disorder are offered the bestpossible care, irrespective of labels. We arealso very much aware of the undeniableburden associated with mood instabilityand hope that the supplement we helpedproduce will assist general practitioners, inparticular, to deliver better care to patientsso afflicted.

David J Castle, Chair of Psychiatry1

Michael Berk, Professor of Psychiatry1

Barbara M Hocking, Executive Director2

1 University of Melbourne, Melbourne, VIC.2 SANE Australia, Melbourne, VIC.david.castle@svhm.org.au

1 Castle DJ, Berk M, Hocking BM. Bipolar disorder:new understandings, emerging treatments. Med JAust 2010; 193 (4 Suppl): S3-S4.

2 Tiller JWG and Schweitzer I. Bipolar disorder: diag-nostic issues. Med J Aust 2010; 193 (4 Suppl): S5-S9. ❏