Specificity of mixed affective states: clinical comparison of dysphoric mania and agitated depression

Swann, Alan C.; Secunda, Steven K.; Katz, Martin Μ.; Croughan, Jack; Bowden, Charles L.; Koslow, Stephen H.; Berman, Nancy; Stokes, Peter E.

doi:10.1016/0165-0327(93)90036-j

Cited by 87 publications

(53 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These are the first randomized, blinded maintenance data to indicate that patients with dysphoric manic features are particularly sensitive to adverse effects from at least divalproex and lithium. Plausible reasons that could be tested in future studies are that dysphoric symptomatology may include heightened subjective sensitivity to adverse drug effects, or that the neurobiology of dysphoric mania predisposes to higher adverse effect burden at a given treatment dosage (Swann et al, 1993). They provide unanticipated evidence on maintenance outcomes for initially euphoric mania patients, with lithium appearing to worsen depression, whereas divalproex and placebo maintained depressive symptomatology at the level present at randomization.…”

Section: Discussionmentioning

confidence: 99%

Relationship of Mania Symptomatology to Maintenance Treatment Response with Divalproex, Lithium, or Placebo

Bowden

Collins

McElroy

et al. 2005

Neuropsychopharmacol

View full text Add to dashboard Cite

Euphoric and mixed (dysphoric) manic symptoms have different response patterns to divalproex and lithium in acute mania treatment, but have not been studied in relationship to maintenance treatment outcomes. We examined the impact of initial euphoric or dysphoric manic symptomatology on maintenance outcome. Randomized maintenance treatment with divalproex, lithium, or placebo was provided for 372 bipolar I patients, who met improvement criteria during open phase treatment for an index manic episode. The current analysis grouped patients according to the index manic episode subtype (euphoric or dysphoric), and evaluated the impact on maintenance treatment outcome. The rate of early discontinuation due to intolerance during maintenance treatment was higher for initially dysphoric patients (N ¼ 249) than euphoric patients (N ¼ 123; 15.7 vs 7.3%, respectively; p ¼ 0.032). Both lithium (23.2%) and divalproex (17.1%) were associated with more premature discontinuations due to intolerance than placebo (4.8%; p ¼ 0.003 and 0.02, respectively) in the initially dysphoric patients. Among initially euphoric patients, treatment with lithium was associated with significantly more premature discontinuations due to intolerance compared to placebo (18.2 vs 0%; p ¼ 0.03), and divalproex was significantly (p ¼ 0.05) more effective than lithium, but not placebo in delaying time to a depressive episode. Initial euphoric mania appeared to predispose to better outcomes on indices of depression and overall function with divalproex maintenance than with either placebo or lithium. Dysphoric mania appeared to predispose patients to more side effects when treated with either divalproex or lithium during maintenance therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Relationship of Mania Symptomatology to Maintenance Treatment Response with Divalproex, Lithium, or Placebo

Bowden

Collins

McElroy

et al. 2005

Neuropsychopharmacol

View full text Add to dashboard Cite

show abstract

“…Our results differed from McElroy et al's whose scores were similar between groups of patients with manic and mixed episodes. 8,[15][16] As stated before, some studies show that manic patients have higher manic scores than patients with mixed episodes. A possible explanation for this is that patients in mixed episode may seek for treatment earlier than manic patients due to the presence of more severe depressive symptoms.…”

Section: 814mentioning

confidence: 92%

“…15 However, they applied a scale rarely used by other authors (Affective Disorders Scale [ADRS], Murphy et al). Baker et al described higher Young Mania Rating Scale (YMRS) scores in a large sample of patients with mixed episodes.…”

Section: 12mentioning

confidence: 99%

A clinical study comparing manic and mixed episodes in patients with bipolar disorder

Schwartzmann

Amaral

Issler

et al. 2007

Rev. Bras. Psiquiatr.

View full text Add to dashboard Cite

A clinical study comparing manic and mixed episodes in patients with bipolar disorder Estudo clínico comparativo entre episódios de mania e mistos em pacientes com transtorno bipolar A b s t r a c t Objective: Mixed episodes have been described as more severe than manic episodes, especially due to their longer duration and their association with higher rates of suicide attempts, hospitalization and psychotic symptoms. The purpose of this study was to compare the severity between mixed and pure manic episodes according to DSM-IV criteria, through the evaluation of sociodemographic data and clinical characteristics. Method: Twenty-nine bipolar I patients presenting acute mixed episodes were compared to 20 bipolar I patients with acute manic episodes according to DSM-IV criteria. We analyzed (cross-sectionally) episode length, presence of psychotic symptoms, frequency of suicide attempts and hospitalization, Young Mania Rating Scale scores, Hamilton Depression Rating Scale scores and the Clinical Global Assessment Scale scores. Results: Young Mania Rating Scale scores were higher in manic episodes than in mixed episodes. There were no differences in gender frequency, CGI scores and rates of hospitalization, suicide attempts and psychotic symptoms, when mixed and manic episodes where compared.Patients with mixed episodes were younger. Conclusion: In our sample, mixed states occurred at an earlier age than manic episodes. Contrary to previous reports, we did not find significant differences between manic and mixed episodes regarding severity of symptomatology, except for manic symptoms ratings, which were higher in acute manic patients. In part, this may be explained by the different criteria adopted on previous studies.Descriptors: Comparative study; Psychotic disorders; Bipolar disorder; Suicide, attempt; Hospitalization Resumo Objetivo: Estados mistos têm sido descritos como mais graves que episódios de mania, especialmente pela maior duração dos episódios, maiores taxas de suicídio, hospitalização e sintomas psicóticos. O objetivo deste estudo foi comparar a severidade entre episódios mistos e mania pura definidos segundo critérios do DSM-IV, avaliando-se características clínicas e sociodemográficas dos pacientes. Método: Vinte e nove pacientes bipolares do tipo I em estado misto foram comparados a 20 pacientes bipolares do tipo I em episódio de mania aguda de acordo com os critérios do DSM-IV. Analisou-se transversalmente a duração dos episódios, presença de sintomas psicóticos, tentativa de suicídio, hospitalização, escores da Escala de Sintomas de Mania de Young, escores da Escala de Depressão de Hamilton e Escala de Avaliação Clínica Global. Resultados: As pontuações na escala de avaliação de mania de Young foram maiores nos episódios de mania quando comparadas às de episódios mistos. Não houve diferença estatisticamente significativa na freqüência de gêneros, nas pontuações da CGI, nas taxas de hospitalização, tentativa de suicídio e sintomas psicóticos entre episódios mistos e de mania. Pacientes com episód...

show abstract

“…[19][20]24,[27][28][29] Psychotic symptoms and irritability seem to be constantly present in episodes with mixed symptomatology. 7,16,24,[29][30][31][32][33] MS are associated with higher rates of impulsiveness and suicidality (suicide ideation, attempts and act). [34][35][36][37] Therefore, the disease with this pattern shows higher morbidity and mortality.…”

Section: Source: Dsm-iv Adaptedmentioning

confidence: 99%

Diagnóstico e tratamento dos estados mistos

Schwartzmann

Lafer

2004

Rev. Bras. Psiquiatr.

View full text Add to dashboard Cite

show abstract

Specificity of mixed affective states: clinical comparison of dysphoric mania and agitated depression

Cited by 87 publications

References 15 publications

Relationship of Mania Symptomatology to Maintenance Treatment Response with Divalproex, Lithium, or Placebo

Relationship of Mania Symptomatology to Maintenance Treatment Response with Divalproex, Lithium, or Placebo

A clinical study comparing manic and mixed episodes in patients with bipolar disorder

Diagnóstico e tratamento dos estados mistos

Contact Info

Product

Resources

About