Factorial structure of the maniac syndrome: litterature review and resultsof the French "EPIMAN" study

Despite the central place of mania in bipolar disorders, few studies were d edicated to syndromal categorization and to factor analysis of signs and sy mptoms of mania. This paper derives from the French national multisite coll aborative study on the clinical epidemiology of mania (EPIMAN), In this rep ort, we focus on data obtained from a structure factor. analysis of manic s yndrome irt a cohort of 104 hospitalized patients presenting an acute manic episode. These data will be compared to those previously reported in the l iterature. Method: EPIMAN involves training 23 French psychiatrists in 4 different sit es to rigorously apply a common protocol deriving from the criteria of DSM- IV, and McElroy et al.; the use of such instruments as rite Beigel-Murphy s cale (Manic State Rating Scale, MSRS), the Ahearn-Carroll Bipolarity Scale, a modified HAMD, and the Semi-Structured Interview for Evaluation of Affec tive Temperaments (based on Akiskal-Mallyn), A principal component analysis (with varimax rotation) was conducted on the MSRS and comparative statisti cal analyses on individual scores were conducted according to mania subcate gorization (pure versus dysphoric). Results: Before rotation, eight factors were identified from which three ma jor factors explained respectively.. 23.3% (FI = "Manic syndrome"), 14.8% ( F2 = "Hostility Dysphoria") and 9.1% (F3 = "Psychosis) of the total varianc e. After varimax rotation, seven interpretable and clinically relevant fact ors were identified: F2 "Desinhibition-Instability", F2 "Paranoia-Hostility ", F3 "Judgement and Appearence (Deficit)", F4 "Grandiosity-Psychosis ", F5 "Elation-Euphoria ", F6 "Depressive dysphoria " and F7 "Hypersexuality". M oreover the data showed 1) negative correlation between F2 and F5; 2) separ ation between F2 and F6; 3) absence of correlation between any component of mania and global severity or impairment of functioning; 4) higher scores o n factors F3, F4 and F5 in pure martin and on F6 in dysphoric mania. Global ly, the EPIMAN data seemed to be similar to another repel;: on a factor ana lysis of the symptoms of mania (Cassidy et al., 1998). Conclusion: Conventional phenomenology of mania as unidimensional was not c onfirmed in this study. The evidence for a nuclear component of mania assoc iated with distinct emotional presentations (euphoric or classic depressed and dysphoric) would adress important issues and perspectives in clinical a nd treatment research.