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Multidimensional structure of acute mania: influence of affective temperaments


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.


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%).


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.


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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Akiskal, H., Hantouche, EG., Azorin, JM. et al. Multidimensional structure of acute mania: influence of affective temperaments. Ann Gen Psychiatry 5 (Suppl 1), S140 (2006).

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