Signs and symptoms of mania in pure and mixed episodes

Background: Debate continues about the diagnosis of mixed mania and the res trictiveness of the DSM-III-R and DSM-IV criteria for Bipolar Disorder, mix ed. Although awareness of dysphoric features during mania continues to grow , standard mania rating instruments do not adequately assess mixed states a nd there is a striking disparity between the dysphoric signs and symptoms e mphasized in research studies and the commonly employed DSM criteria. Metho ds: 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 diagnost ic subtypes and compared using chi(2) statistics and conditional probabilit y parameters. Results: The most frequently noted signs and symptoms in mani a are motor activation, accelerated thought process, pressured speech and d ecreased sleep. Although euphoric mood was present in a large portion of th e cohort, irritability, dysphoric mood and mood lability were also prominen t in the entire cohort. Dysphoric mood, mood lability, anxiety, guilt, suic idality, 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. Cont rary to popular belief, paranoia did not differ significantly between the t wo 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. Li mitations: The comparison of mixed and manic episodes requires the appropri ate definition of mixed states. In the current report we use the DSM-III-R definition of Bipolar Disorder, mixed, which may be too rigid. Conclusions: 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 fo r Bipolar Disorder, mixed, suggesting, that perhaps a less restrictive defi nition of mixed states would be more appropriate. (C) 1998 Elsevier Science B.V. All rights reserved.