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The structure of mania: An overview of factorial analysis studies

  • Diego J. Martino (a1) (a2), Marina P. Valerio (a2) (a3) and Gordon Parker (a4)

Abstract

Background.

Operational definitions of mania are based on expert consensus rather than empirical data. The aim of this study is to identify the key domains of mania, as well as the relevance of the different signs and symptoms of this clinical construct.

Methods.

A review of latent factor models studies in manic patients was performed. Before extraction, a harmonization of signs and symptoms of mania and depression was performed in order to reduce the variability between individual studies.

Results.

We identified 12 studies fulfilling the inclusion criteria and comprising 3039 subjects. Hyperactivity was the clinical item that most likely appeared in the first factor, usually covariating with other core features of mania, such as increased speech, thought disorder, and elevated mood. Depressive–anxious features and irritability–aggressive behavior constituted two other salient dimensions of mania. Altered sleep was frequently an isolated factor, while psychosis appeared related to grandiosity, lack of insight and poor judgment.

Conclusions.

Our results confirm the multidimensional nature of mania. Hyperactivity, increased speech, and thought disorder appear as core features of the clinical construct. The mood experience could be heterogeneous, depending on the co-occurrence of euphoric (elevated mood) and dysphoric (irritability and depressive mood) emotions of varying intensity. Results are also discussed regarding their relationship with other constitutive elements of bipolar disorder, such as mixed and depressive states.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Diego J. Martino, E-mail: diejmartino@gmail.com

References

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[1]Kraepelin, E. Psychiatrie. Ein Lehrbuch fur Studierende und Arzte. III. Bd. Klinische Psychiatrie. II. Teil (8. Volstandigumgearbeitete Auflage). Leipzig, Germany: Johann Ambrosius Barth, 1913.
[2]Kendler, KS. The clinical features of mania and their representation in modern diagnostic criteria. Psychol Med. 2017;47(6):10131029.
[3]Taylor, M, Abrams, R. Manic states. A genetic study of early and late onset affective disorders. Arch Gen Psychiatry. 1973;28(5):656658.
[4]Young, MA, Abrams, R, Taylor, MA, Meltzer, HY. Establishing diagnostic criteria for mania. J Nerv Ment Dis. 1983;171(11):676682.
[5]Feighner, JP, Robins, E, Guze, SB, Woodruff, RA Jr, Winokur, G, Munoz, R. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry. 1972;26(1):5763.
[6]Spitzer, RL, Endicott, J, Robins, E. Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry. 1978;35(6):773782.
[7]Benazzi, F. Is overactivity the core feature of hypomania in bipolar II disorder? Psychopathology. 2007;40(1):5460.
[8]Scott, J, Murray, G, Henry, C, Morken, G, Scott, E, Angst, J, et al.Activation in bipolar disorders: a systematic review. JAMA Psychiatry. 2017;74(2):189196.
[9]Harvey, PD, Endicott, JM, Loebel, AD. The factor structure of clinical symptoms in mixed and manic episodes prior to and after antipsychotic treatment. Bipolar Disord. 2008;10(8):900960.
[10]Rossi, A, Daneluzzo, E, Arduini, L, Di Domenico, M, Pollice, R, Petruzzi, C. A factor analysis of signs and symptoms of the manic episode with Bech-Rafaelsen Mania and Melancholia Scales. J Affect Disord. 2001;64(2–3):267270.
[11]Swann, AC, Janicak, PL, Calabrese, JR, Bowden, CL, Dilsaver, SC, Morris, DD, et al.Structure of mania: depressive, irritable, and psychotic clusters with different retrospectively-assessed course patterns of illness in randomized clinical trial participants. J Affect Disord. 2001;67(1–3):123132.
[12]Swann, AC, Suppes, T, Ostacher, MJ, Eudicone, JM, McQuade, R, Forbes, A, et al.Multivariate analysis of bipolar mania: retrospectively assessed structure of bipolar I manic and mixed episodes in randomized clinical trial participants. J Affect Disord. 2013;144(1–2):5964.
[13]Akiskal, H.S., Azorin, J.M., Hantouche E.G. Proposed multidimensional structure of mania: beyond the euphoric-dysphoric dichotomy. J Affect Disord. 2003; 73: 718.
[14]Dilsaver, SC, Chen, YR, Shoaib, AM, Swann, AC. Phenomenology of mania: evidence for distinct depressed, dysphoric, and euphoric presentations. Am J Psychiatry. 1999;156(3):426430.
[15]González-Pinto, A, Ballesteros, J, Aldama, A, Pérez de Heredia, JL, Gutierrez, M, Mosquera, F, et al.Principal components of mania. J Affect Disord. 2003;76(1–3):95102.
[16]Sato, T, Bottlender, R, Kleindienst, N, Möller, HJ. Syndromes and phenomenological subtypes underlying acute mania: a factor analytic study of 576 manic patients. Am J Psychiatry. 2002;159(6):968974.
[17]Cassidy, F., Forest, K., Murry, E., Carrol, B.J.A factor analysis of the signs and symptoms of mania. Arch Gen Psychiatry. 1998; 55(1): 2732.
[18]von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC, Vandenbroucke, JP, et al.The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344349.
[19]Double, DB. The factor structure of manic rating scales. J Affect Disord. 1990;18(2):113119.
[20]Kumar, R, Sinha, BN, Chakrabarti, N, Sinha, VK. Phenomenology of mania—a factor analysis approach. Indian J Psychiatry. 2001;43(1):4651.
[21]Picardi, A, Battisti, F, de Girolamo, G, Morosini, P, Norcio, B, Bracco, R, et al.Symptom structure of acute mania: a factor study of the 24-item Brief Psychiatric Rating Scale in a national sample of patients hospitalized for a manic episode. J Affect Disord. 2008;108(1–2):183189.
[22]Gupta, SC, Sinha, VK, Praharaj, SK, Gandotra, S. Factor structure of manic symptoms. Aust N Z J Psychiatry. 2009;43(12):11411146.
[23]Hanwella, R, de Silva, VA. Signs and symptoms of acute mania: a factor analysis. BMC Psychiatry. 2011;11:137.
[24]Filgueiras, A, Nunes, AL, Silveira, LA, de Assis da Silva, R, da Silva, RO, Landeira-Fernandez, J, et al.Latent structure of the symptomatology of hospitalized patients with bipolar mania Eur Psychiatry. 2014;29(7):431436.
[25]Güclü, O, Şenormancı, Ö, Aydın, E, Erkıran, M, Köktürk, F. Phenomenological subtypes of mania and their relationships with substance use disorders. J Affect Disord. 2015;174:569573.
[26]Adhikari, SP. Factor analysis study of phenomenological subtypes of mania. Ann Psychiatry Clin Neurosci. 2019;2(1): 1009.
[27]Comrey, AL. Common methodological problem in factor analytic studies. J Consult Clin Psychol. 1978;48:648649.
[28]Streiner, DL. Figuring out factors: the use and misuse of factor analysis. Can J Psychiatry. 1994;39:135140.
[29]Goodwin, FK, Jamison, KR. Manic depressive illness: bipolar disorders and re-current depression. New York: Oxford University Press, 2007.
[30]Murphy, DL, Beigel, A. Depression, elation, and lithium carbonate responses in manic patient subgroups. Arch Gen Psychiatry. 1974;31(5):643648.
[31]Akiskal, HS, Hantouche, EG, Bourgeois, ML, Azorin, JM, Sechter, D, Allilaire, JF, et al.Toward a refined phenomenology of mania: combining clinician-assessment and self-report in the French EPIMAN study. J Affect Disord. 2001;67(1–3):8996.
[32]Henry, C, Swendsen, J, Van den Bulke, D, Sorbara, F, Demotes-Mainard, J, Leboyer, M. Emotional hyper-reactivity as a fundamental mood characteristic of manic and mixed states. Eur Psychiatry. 2003;18(3):124128.
[33]Henry, C, M’Baïlara, K, Desage, A, Gard, S, Misdrahi, D, Vieta, E. Towards a reconceptualization of mixed states, based on an emotional-reactivity dimensional model. J Affect Disord. 2007;101(1–3):3541.
[34]Henry, C, M’Bailara, K, Mathieu, F, Poinsot, R, Falissard, B. Construction and validation of a dimensional scale exploring mood disorders: MAThyS (Multidimensional Assessment of Thymic States). BMC Psychiatry. 2008;8:82. doi: 10.1186/1471-244X-8-82.
[35]M’Bailara, K, Atzeni, T, Colom, F, Swendsen, J, Gard, S, Desage, A, et al.Emotional hyperreactivity as a core dimension of manic and mixed states. Psychiatry Res. 2012;197(3):227230.
[36]Akiskal, HS, Hantouche, EG, Bourgeois, ML, Azorin, JM, Sechter, D, Allilaire, JF, et al.Gender, temperament, and the clinical picture in dysphoric mixed mania, findings from a French national study (EPIMAN). J Affect Disord. 1998;50:175186.
[37]Akiskal, HS, Benazzi, F. Toward a clinical delineation of dysphoric hypomania—operational and conceptual dilemmas. Bipolar Disord. 2005;7(5):456464.
[38]Koukopoulos, A, Sani, G, Ghaemi, SN. Mixed features of depression: why DSM-5 is wrong (and so was DSM-IV). Br J Psychiatry. 2013;203(1):35.
[39]Maj, M. "Mixed" depression: drawbacks of DSM-5 (and other) polythetic diagnostic criteria. J Clin Psychiatry. 2015;76(3):e381e382.
[40]Parker, G, Ricciardi, T. Mixed states in bipolar disorder: modelling, measuring and managing. Australas Psychiatry. 2019;27(1):6971.
[41]Dilsaver, SC, Chen, YW, Swan, AC, Shoaib, AM, Krajewski, KJ. Suicidality in patients with pure and depressive mania. Am J Psychiatry. 1994;151:13121315.
[42]Vieta, E. The treatment of mixed states and the risk of switching to depression. Eur Psychiatry. 2005;20:96100.
[43]Joffe, RT, Young, LT, MacQueen, GM. A two-illness model of bipolar disorder. Bipolar Disord. 1999;1(1):2530.
[44]Schweitzer, I, Maguire, K, Ng, CH. Should bipolar disorder be viewed as manic disorder? Implications for bipolar depression. Bipolar Disord. 2005;7(5):418423.
[45]Merikangas, KR, Cui, L, Heaton, L, Nakamura, E, Roca, C, Ding, J, et al.Independence of familial transmission of mania and depression: results of the NIMH family study of affective spectrum disorders. Mol Psychiatry. 2014;19(2):214219.
[46]Vandeleur, CL, Merikangas, KR, Strippoli, MP, Castelao, E, Preisig, M. Specificity of psychosis, mania and major depression in a contemporary family study. Mol Psychiatry. 2014;19(2):209213.
[47]Martino, DJ, Szmulewicz, AG, Valerio, MP, Parker, G. Melancholia: an attempt at definition based on a review of empirical data. J Nerv Ment Dis. 2019;207(9):792798.
[48]Marneros, A. Origin and development of concepts of bipolar mixed states. J Affect Disord. 2001;67(1–3):229240.
[49]Hickie, IB. Evidence for separate inheritance of mania and depression challenges current concepts of bipolar mood disorder. Mol Psychiatry. 2014;19(2):153155.
[50]Malhi, GS, Irwin, L, Hamilton, A, Morris, G, Boyce, P, Mulder, R, et al.Modelling mood disorders: an ACE solution? Bipolar Disord. 2018;20(Suppl 2):416.
[51]Dargél, AA, Masson, M. Bipolar disorder: a single illness. Bipolar Disord. 2018;20(5):492493. 10.1111/bdi.12651.
[52]Malhi, GS, Byrow, Y, Boyce, P, Bassett, D, Fitzgerald, PB, Hopwood, M, et al.Why the hype about subtype? Bipolar I, bipolar II – it’s simply bipolar, through and through! Aust N Z J Psychiatry. 2016;50(4):303306.

Keywords

The structure of mania: An overview of factorial analysis studies

  • Diego J. Martino (a1) (a2), Marina P. Valerio (a2) (a3) and Gordon Parker (a4)

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The structure of mania: An overview of factorial analysis studies

  • Diego J. Martino (a1) (a2), Marina P. Valerio (a2) (a3) and Gordon Parker (a4)
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