Multidimensional structure of acute mania: influence of affective temperaments

Background

Previous data deriving from EPIMAN (104 patients) study had suggested a rich multidimensional phenomenology of mania beyond the conventional dichotomy of euphoric versus dysphoric forms (Akiskal et al., 2003).

Materials and methods

"EPIMAN-II Thousand" is a national multi-site collaborative study dedicated to the clinical sub-types of mania. It involved training 317 French psychiatrists working in different sites representative of all France. The study actually succeeded in recruiting 1090 cases admitted for acute mania (DSM-IV criteria). Manic symptomatology was assessed using the Mania Rating Scale (MRS; 10 items). A checklist of depressive symptoms, CLDS (McElroy et al. modified, 10 items) and MADRS (10 items) were used to assess co-existing depression. Principal component analysis (PCA) was conducted after rotation on combined items from MRS + MADRS (20 items). Affective Temperaments (AT) were assessed by using the full TEPMS-A French version (84 items, Hantouche et al., 2001). Correlation analyses were conducted between mean factorial scores and mean scores of the TEMPS-A.

Results

The PCA conducted on the combined "MRS + MADRS" showed, after varimax rotation the presence of 5 major components: core factor "Depression-SAD1" (eigenvalue = 3.7), "Mania-GLAD" (ev = 3.0), "Sleep difficulties" (ev = 1.8), "Psychomotor Inhibition-SAD2" (ev = 1.7), and "Poor Judgment-Irritability-BAD" (ev = 1.6). Correlation coefficients were statistically significant between: factor GLAD and Hyperthymic Temperament, factor SAD- and Depressive Temperament, factors SAD1/SAD2 and Cyclothymic Temperament, and finally between factor BAD/SAD1 and Irritable Temperament. Rates of cases with Cyclothymic, Depressive, and Irritable Temperaments were significantly (p = 0.0022) higher in Mixed Mania versus Pure Mania (respectively 75% vs 44%, 37% vs 22%, 30% vs 21%).

Discussion

Our data obtained on the largest population of manic patients ever conducted (n = 1090) confirmed the multidimensionality of manic syndrome and the major pathoplastic role of Affective Temperaments in modulating the clinical expression of mania.

Funding source

unrestricted grant from Sanofi-Aventis.