Phenomenology of manic episodes according to the presence or absence of depressive features as defined in DSM-5: Results from the IMPACT self-reported online survey

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• 作者：Eduard Vieta ; Heinz Grunze ; Jean-Michel Azorin ; Andrea Fagiolini
• 关键词：Bipolar disorder ; Manic episode ; Mixed features ; Depressive symptoms ; Survey ; Self-reported
• 刊名：Journal of Affective Disorders
• 出版年：1 March, 2014
• 年：2014
• 卷：156
• 期：Complete
• 页码：206-213
• 全文大小：785 K

文摘

Background

The aim of this study was to describe the phenomenology of mania and depression in bipolar patients experiencing a manic episode with mixed features as defined in the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Methods

In this multicenter, international on-line survey (the IMPACT study), 700 participants completed a 54-item questionnaire on demographics, diagnosis, symptomatology, communication of the disease, impact on life, and treatment received. Patients with a manic episode with or without DSM-5 criteria for mixed features were compared using descriptive and inferential statistics.

Results

Patients with more than 3 depressive symptoms were more likely to have had a delay in diagnosis, more likely to have experienced shorter symptom-free periods, and were characterized by a marked lower prevalence of typical manic manifestations. All questionnaire items exploring depressive symptomatology, including the DSM-5 criteria defining a manic episode as 鈥渨ith mixed features鈥? were significantly overrepresented in the group of patients with depressive symptoms. Anxiety associated with irritability/agitation was also more frequent among patients with mixed features.

Limitations

Retrospective cross-sectional design, sensitive to recall bias. Two of the 6 DSM-5 required criteria for the specifier 鈥渨ith mixed features鈥?were not explored: suicidality and psychomotor retardation.

Conclusions

Bipolar disorder patients with at least 3 depressive symptoms during a manic episode self-reported typical symptomatology. Anxiety with irritability/agitation differentiated patients with depressive symptoms during mania from those with 鈥減ure鈥?manic episodes. The results support the use of DSM-5 mixed features specifier and its value in research and clinical practice.