Article

Signs and symptoms of mania in pure and mixed episodes.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
Journal of Affective Disorders (Impact Factor: 3.71). 10/1998; 50(2-3):187-201. DOI: 10.1016/S0165-0327(98)00016-0
Source: PubMed

ABSTRACT Debate continues about the diagnosis of mixed mania and the restrictiveness of the DSM-III-R and DSM-IV criteria for Bipolar Disorder, mixed. Although awareness of dysphoric features during mania continues to grow, standard mania rating instruments do not adequately assess mixed states and there is a striking disparity between the dysphoric signs and symptoms emphasized in research studies and the commonly employed DSM criteria.
Three hundred sixteen inpatients meeting DSM-III-R criteria for Bipolar Disorder, manic or mixed, were evaluated by rating 20 signs and symptoms. The frequencies of these signs and symptoms were computed for both diagnostic subtypes and compared using chi2 statistics and conditional probability parameters.
The most frequently noted signs and symptoms in mania are motor activation, accelerated thought process, pressured speech and decreased sleep. Although euphoric mood was present in a large portion of the cohort, irritability, dysphoric mood and mood lability were also prominent in the entire cohort. Dysphoric mood, mood lability, anxiety, guilt, suicidality, and irritability were the only symptoms significantly more common in the mixed group. In contrast, grandiosity, euphoric mood, and pressured speech were significantly more often observed in the pure manic group. Contrary to popular belief, paranoia did not differ significantly between the two groups. Suicidality was present in a non-trivial 7% of the entire cohort, including some subjects who did not meet the criteria for mixed mania.
The comparison of mixed and manic episodes requires the appropriate definition of mixed states. In the current report we use the DSM-III-R definition of Bipolar Disorder, mixed, which may be too rigid.
The data underscore that mania is not a purely euphoric state. Substantial rates of dysphoria, lability, anxiety and irritability were noted in the "pure" manic patients, as well as in those who meet the full DSM criteria for Bipolar Disorder, mixed, suggesting, that perhaps a less restrictive definition of mixed states would be more appropriate.

0 Bookmarks
 · 
82 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: The vast number of psychopathological syndromes that can be observed in clinical practice can be described in terms of a limited number of elementary syndromes that are differentially expressed. Previous attempts to identify elementary syndromes have shown limitations that have slowed progress in the taxonomy of psychiatric disorders. Aim: To examine the ability of network community detection (NCD) to identify elementary syndromes of psychopathology and move beyond the limitations of current classification methods in psychiatry. Methods: 192 patients with unselected mental disorders were tested on the Comprehensive Psychopathological Rating Scale (CPRS). Principal component analysis (PCA) was performed on the bootstrapped correlation matrix of symptom scores to extract the principal component structure (PCS). An undirected and weighted network graph was constructed from the same matrix. Network community structure (NCS) was optimized using a previously published technique. Results: In the optimal network structure, network clusters showed a 89% match with principal components of psychopathology. Some 6 network clusters were found, including "DEPRESSION", "MANIA", ''ANXIETY'', "PSYCHOSIS", "RETARDATION", and "BEHAVIORAL DISORGANIZATION". Network metrics were used to quantify the continuities between the elementary syndromes. Conclusion: We present the first comprehensive network graph of psychopathology that is free from the biases of previous classifications: a 'Psychopathology Web'. Clusters within this network represent elementary syndromes that are connected via a limited number of bridge symptoms. Many OPEN ACCESS
    PLoS ONE 11/2014; DOI:10.1371/journal.pone.0112734 · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introducción. La escala para manías de la Universidad Nacional de Colombia es un instrumento diseñado para medir la gravedad de la sintomatología maníaca y sólo ha sido validada utilizando técnicas de teoría psicométrica clásica. Objetivos. Determinar las propiedades psicométricas y las características, como instrumento de medición, de la escala para manías mediante análisis basados en la teoría de respuesta al ítem. Materiales y métodos. Se evaluaron 264 pacientes con diagnóstico de episodio maníaco, hipomaníaco o mixto, usando la escala para manías. Se analizaron las características psicométricas del instrumento utilizando un modelo de Rasch de crédito parcial para datos politómicos. Resultados. El análisis mostró que, en contraste con los ítems, los índices de separación y la confiabilidad para personas fueron bajos, lo cual sugiere una posible representación reducida del constructo evaluado en esta muestra. La disminución de la necesidad de dormir fue el ítem más fácilmente detectable en los pacientes maníacos. La mayoría de ítems se ajustó a las expectativas del modelo (excepto el afecto depresivo y la capacidad de distraerse). El diagnóstico de la escala de puntuación mostró que las medidas promedio se incrementan monotónicamente a través de la escala. Dos ítems mostraron redundancia y podrían omitirse en versiones futuras de la escala. El mapa persona-ítem sugiere que el síndrome no queda completamente evaluado por la escala, probablemente debido a que algunos síntomas depresivos no se incluyeron en ella. Conclusiones. En este primer estudio de la escala para manías usando el análisis de Rasch, se detectó mal ajuste y redundancia de algunos ítems. El síndrome maníaco no queda completamente evaluado por la escala. El instrumento podría mejorarse agregando síntomas depresivos. Palabras clave: escalas de valoración psiquiátrica, estudios de validación, trastorno bipolar/diagnóstico, psicometría/estadísticas y datos numéricos, reproducibilidad de resultados, entrevista psicológica. Validation by Rasch analysis of the Mania Scale (EMUN) for measuring manic symptions Introduction. The Mania Scale (EMUN) developed at the Universidad Nacional de Colombia was designed to measure the severity of manic symptoms, but has been validated only using classical psychometric theory. Objectives. The psychometric properties and measuring characteristics of the EMUN scale were determined using an analysis based on item response theory. Materials and methods. Two hundred sixty-four patients with manic, hypomanic or mixed episode symptoms were assessed using the EMUN scale. The psychometric characteristics of the scale were analyzed using a Rasch model for partial credit scoring. Results. The analysis based on the item response theory showed that reliability and separation indexes for persons are low in contrast to items. This suggested a narrow representation of the construct evaluated in this sample. Reduced need to sleep has been the most easily detectable symptom in mania. Excepting depressive affect and distractibility, the majority of items fit the model's expectation The rating scale diagnostics showed that the average measures increase monotonically across the rating scale. Two items showed redundancy and can be omitted in future versions of the scale. The person-item map suggested that the syndrome is not fully evaluated by the scale, probably because some depressive symptoms are not included. Conclusion. In this first study to use Rasch analysis to assess the psychometric properties of the EMUN scale, misfit and redundancy of items have been detected. The manic syndrome is not fully evaluated by the scale. The instrument can be improved by adding depressive symptoms.
    Biomédica: revista del Instituto Nacional de Salud 03/2011; 31(3). DOI:10.7705/biomedica.v31i3.385 · 0.62 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The response styles theory of depression (Nolen-Hoeksema, 1991) proposes three main strategies individuals employ in response to low mood: rumination, active coping (distraction and problem-solving) and risk taking. Although recent research has suggested this theory has utility in understanding the symptoms of bipolar disorder (BD), the role of these processes in conferring vulnerability to the condition is poorly understood. Twenty-three adolescent children of patients with BD and 25 offspring of well parents completed the Experience Sampling Method (ESM; Csikszentmihalyi and Larson, 1987) diary for six days. Longitudinal analyses were carried out to examine inter-relationships between mood, self-esteem and response styles. Increased negative as well as positive mood resulted in greater rumination in both groups. Low self-esteem triggered greater risk-taking at the subsequent time point in the at-risk group, while negative affect instigated increased active coping in the control group. In both groups, engagement in risk-taking improved mood at the subsequent time point, whilst rumination dampened self-esteem. Differential longitudinal associations between mood, self-esteem and response styles between at-risk and control children suggest early psychological vulnerability in the offspring of BD parents, with important indications for early intervention. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 12/2014; DOI:10.1016/j.psychres.2014.11.046 · 2.68 Impact Factor

Full-text

Download
27 Downloads
Available from
Oct 21, 2014