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The clinical features of mania and their representation in modern diagnostic criteria

Published online by Cambridge University Press:  19 December 2016

K. S. Kendler
K. S. Kendler*
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
*
*Address for correspondence: K. S. Kendler, MD, Virginia Institute of Psychiatric and Behavioral Genetics, Departments of Psychiatry and Human and Molecular Genetics, Medical College of Virginia/Virginia Commonwealth University, Richmond, Box 980126, Richmond, VA 23298-0126, USA. (Email: Kenneth.Kendler@vcuhealth.org)
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Abstract

This review seeks to determine the degree to which modern operationalized diagnostic criteria for mania reflect the clinical features of mania described historically by expert textbook authors. Clinical descriptions of mania appearing in 18 textbooks published between 1899 and 1956 were reviewed and compared to the criteria for mania from six modern operationalized diagnostic systems. Twenty-two prominent symptoms and signs were reported by five or more authors. Two symptoms (elevated mood and grandiosity) and four signs (hyperactivity, pressured speech, irritability, and new activities with painful consequences) were reported by every author. A strong relationship was seen between the frequency with which the clinical features were reported and the likelihood of their inclusion in modern diagnostic systems. However, many symptoms and signs including impulsivity, hypersexuality, mood lability, altered moral standards, increased humor, hypergraphia, and a vigorous physical appearance were not included in any modern criteria. Indeed, DSM-5 contains only eight of the historically noted clinical features. We conclude that modern operationalized criteria for mania well reflect symptoms and signs frequently reported by historical experts. This suggests that the clinical construct of mania has been relatively stable in western Psychiatry since the turn of the 20th century. However, many useful clinical features of mania described in these textbooks are missing from these criteria thereby illustrating the limitations of clinical evaluations restricted to the assessment of only current diagnostic criteria. The disorders we study and treat are considerably richer clinically than is reflected in the DSM criteria which we use to diagnose them.

Keywords

DSMhistoryKraepelinmaniapsychiatric nosology
Type
Review Article
Information
Psychological Medicine , Volume 47 , Issue 6 , April 2017 , pp. 1013 - 1029
Copyright
Copyright © Cambridge University Press 2016 

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