Mood versus energy/activity symptoms in bipolar disorder: which cluster of Hamilton Depression Rating Scale better distinguishes between mania, depression, and euthymia?

Abstract

Introduction Although bipolar disorder (BD) is traditionally included among mood disorders, some authors believe that changes in energy and motor activity, rather than mood changes, represent the true cardinal symptoms in mania and depression. The aim of the current study was to identify which cluster of the Hamilton Depression Rating Scale (HAM-D) better distinguishes between mania, depression and euthymia. Method A group of 106 patients with BD were followed for 13 years and repeatedly assessed with the HAM-D as well as with other clinical scales. To perform a comparison, HAM-D items were classified according to clinical criteria into three clusters: energy/activity symptoms, mood symptoms, and other symptoms. Item response theory (IRT) analyses were performed to provide a test information curve for those three clusters. We measured the prevalence of one cluster of symptoms over the other two throughout the latent trait. Results Considering HAM-D items individually, the IRT analysis revealed that there was a mixture of mood and energy/activity symptoms among the most discriminative items, both in depression and in euthymia. However, in mania, only energy/activity symptoms – i.e., general somatic symptoms and retardation – were among the most informative items. Considering the classification of items, both in depression as in mania, the energy/activity cluster was more informative than the mood cluster according to the IRT analysis. Conclusion Our data reinforce the view of hyperactivity and motor retardation as cardinal changes of mania and depression, respectively.

Mood or energy/activity symptoms in bipolar mania: which are the most informative?

“…Previous studies that made this comparison between these two symptom groups reported similar results. 21,22 Results of factor analyses of manic symptoms, assessments of motor activity using clinical observation scales, and actigraphic studies point in the same direction.…”

“…Other studies that compared energy or activity symptoms with mood symptoms also influenced this arrangement. [20][21][22] Considering that each group of symptoms was composed of a different number of items, we calculated the average of each of these items to make comparisons possible.…”

“…Items that were related to mood symptoms on both scales were less important for this differentiation. The other study 22 evaluated the same sample but applied only the Hamilton Depression Scale. According to their IRT analysis, items that were related to energy and motor activity were more informative than items that were related to mood.…”

Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment

“…The possibility of an underlying bipolar disorder should be considered in psychotically depressed patients with subtle hypomanic features such as intense irritability, aggression, or impatience, lack of sleep without feeling tired, increased sexual interest, lack of anhedonia, and increased physical or mental activity despite complaints of severe fatigue. A bipolar component may also be suggested by early onset, highly recurrent depression with an acute onset, dramatic psychosis that is not associated with impaired functioning, nonauditory hallucinations, hallucinations without delusions, bipolar first-degree relatives, or any mood disorder in multiple generations [43,[119][120][121][122][123].…”

The Metabolic Overdrive Hypothesis. Hyperglycolysis and Glutaminolysis in Bipolar Mania.

“…People with bipolar disorder in manic, hypomanic, and mixed states engage in higher levels of physical exercise than those who are depressed. Many even feel a compulsion to exercise and will substantially increase their level of physical activity during mania [8][9][10]. Conversely, exhaustion and lack of energy are characteristic of bipolar depression.…”