Signs and symptoms of mania in pure and mixed episodes. J Affect Disord 50(2-3):187-201

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 10/1998; 50(2-3):187-201. DOI: 10.1016/S0165-0327(98)00016-0
Source: PubMed


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.

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Available from: Bernard J Carroll, Oct 21, 2014
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    • "The results of the present study are similar to those of a previous study. Depressive symptoms associated with mixed manic episodes in this study included dysphoric mood, anxiety, excessive guilt, and suicidality (Cassidy et al., 1998). The results of the present study agree well with the previous study in the high prevalence of psychotic symptoms (Gonzalez-Pinto et al., 2004). "
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    • "Therefore, the non-planning or motor aspect of impulsivity may be related to these disorders. Patients with bipolar disorder have greater motor activation (Cassidy et al., 1998) as well as manic symptoms including elevated mood, a decreased need for sleep, and increased verbal expression , which may make the patients more impulsive. Their impulsivity contributes to the highly recursive course of illness, comorbid Table 1 Demographic and clinical characteristics of the participants. "
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