Skip to main content Accessibility help
×
Home
Hostname: page-component-564cf476b6-wkm24 Total loading time: 0.168 Render date: 2021-06-21T14:39:50.881Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }

Emotional hyper-reactivity as a fundamental mood characteristic of manic and mixed states

Published online by Cambridge University Press:  16 April 2020

Chantal Henry
Affiliation:
Service de Psychiatrie Adulte, Centre Hospitalier Charles Perrens, 121, rue de la Béchade, 33076Bordeaux, France
Joel Swendsen
Affiliation:
Département de Psychologie, Université de Bordeaux 2, 3 ter, place de la Victoire, 33076Bordeaux, France
Donatienne Van den Bulke
Affiliation:
Service de Psychiatrie Adulte, Centre Hospitalier Charles Perrens, 121, rue de la Béchade, 33076Bordeaux, France
Frederic Sorbara
Affiliation:
Service de Psychiatrie Adulte, Centre Hospitalier Charles Perrens, 121, rue de la Béchade, 33076Bordeaux, France
Jacques Demotes-Mainard
Affiliation:
Centre d’Investigation Clinique, INSERM-CHU de Bordeaux, France
Marion Leboyer
Affiliation:
Hopital Albert Chenevier, AP-HP 40, rue de Mesly, 94010Créteil cedex, France INSERM U-513, Faculté de Médecine, 8, rue du Général-Sarrail, 94000Créteil, France
Corresponding
Get access

Abstract

Background

The relationship between depression and mania remains poorly understood and is responsible for much of the confusion about mixed states. The difficulty in conceptualizing opposite states such as euphoric and depressive moods during the same episode may account for the considerable differences in reported frequencies of mixed states, among acutely manic patients. It is possible that the fundamental mood characteristic of mania is not tonality of mood (e.g. euphoric, irritable or depressed mood), but rather the intensity of emotions.

Methods

We interviewed 30 patients hospitalized for a manic episode, asking about their symptoms during the episode, using the list of symptoms for manic and depressive episode of the DSM-IV criteria. Emotional hyper-reactivity, defined as an increase in the intensity of all emotions, was assessed using the Hardy Scale. Manic symptoms were also assessed by a clinician using the Beck–Rafaelsen Mania Scale.

Results

This study showed that most of the manic episodes presented many dysphoric symptoms, more particularly depressive mood (33%), irritability (53%), anxiety (76%), and recurrent thoughts of death or suicidal ideation (33%). However, only 10% of our sample met the criteria for mixed state. The other symptoms reported by patients and included in the DSM-IV criteria for depressive mood are common between depressive and manic episodes. All patients (100%) reported that they felt all their emotions with an unusual intensity.

Conclusions

We suggest that the most appropriate way to define mood in manic states is as a function of intensity, and not as a function of tonality. This definition circumvents the arbitrary dichotomy between mania and mixed state. With this definition, manic episodes can be described as being more or less dysphoric, with the actual characteristics of dysphoria encompassing irritability, anxiety, or depressive affect. This point could be extremely helpful in discriminating mixed state or dysphoric mania from depression.

Type
Original article
Copyright
Copyright © Éditions scientifiques et médicales Elsevier SAS 2003

Access options

Get access to the full version of this content by using one of the access options below.

References

Akiskal, HS, Hantouche, EG, Bourgeois, ML, Azorin, JM, Sechter, D, Allilaire, JF, et al.Gender, temperament, and the clinical picture in dysphoric mania: findings from a French national study (EPIMAN). J Affective Dis 1998;50:175–86.CrossRefGoogle Scholar
American Psychiatric Association. DSM-IV: diagnostic and statistical manual of mental disorders. 4th. Washington (DC): APA; 1994.Google Scholar
Bauer, MS, Whybrow, PC, Gyulai, L, Gonnel, J, Yeh, HS. Testing definitions of dysphoric mania and hypomania: prevalence, clinical characteristics and inter-episode stability. J Affective Dis 1994;32: 201–11.CrossRefGoogle ScholarPubMed
Bech, P, Rafaelsen, OJ, Kramp, P, Bolwig, TG. The mania rating scale. Scale construction and inter-observer agreement. Neuropharmacol-ogy 1978;17:430–1.CrossRefGoogle ScholarPubMed
Cassidy, F, Murry, E, Forest, K, Carroll, BJ. Signs and symptoms of mania in pure and mixed episodes. J Affective Dis 1998;50:187201.CrossRefGoogle ScholarPubMed
Dell’Osso, L, Placidi, GF, Nassi, R, Freer, P, Cassano, GB, Akiskal, HS. The manic-depressive mixed state: familial, temperamental and psy-chopathologic characteristics in 108 female inpatients. Eur Arch Psychiatry Clin Neurosci 1991;240:234–9.CrossRefGoogle ScholarPubMed
Dilsaver, SC, Chen, R, Shoaib, AM, Swann, AC. Phenomenology of mania: evidence for distinct depressed, dysphoric, and euphoric presentations. Am J Psychiatry 1999;156:426–30.Google ScholarPubMed
Evans, Dl, Nemerof, CB. The dexamethasone suppression test in mixed bipolar disorder. Am J Psychiatry 1983;140:615–7.Google ScholarPubMed
Goodwin, FK, Jamison, KR. Manic-depressive illness. New York: Oxford University Press; 1990.Google Scholar
Hardy, MC. Pour une nouvelle approche de la manie. Annales Médico-Psychologiques 1986;144(4):357–73.Google Scholar
Henry, C. Du concept d’état mixte à la dimension dysphorique des manies. Paris: Doin; 1999.Google Scholar
Henry, C, Lacoste, J, Bellivier, F, Verdoux, H, Bourgeois, ML, Leb-oyer, M. Temperament in bipolar illness: impact on prognosis. JAffec-tive Dis 1999;56:103–8.CrossRefGoogle ScholarPubMed
Henry, C, Sorbara, F, Lacoste, J, Gindre, C, Leboyer, M. Antidepressant-induced mania: identification of risk factors. J Clin Psychiatry 2001;62(4):249–55.CrossRefGoogle ScholarPubMed
Keller, MB, Lavori, PW, Coryell, W, reasen, NC, Endicott, J, Clayton, PJ, et al.Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness. J Am Med Assoc 1986;255(22):3138–42.CrossRefGoogle ScholarPubMed
Kraepelin, E. La folie Maniaco-Dépressive. 1913 [trad. fr. Géraud, M., Bordeaux, Mollat eds., 1997, p. 149351].Google Scholar
Kotin, J, Goodwin, FK. Depression during mania: clinical observations and theoretical implications. Am J Psychiatry 1972;29(6):679–86.CrossRefGoogle Scholar
Koukopoulos, A, Koukopoulos, A. Agitated depression as a mixed state and the problem of melancholia. Psychiatric Clin N Am 1999;22(3): 547–64.CrossRefGoogle ScholarPubMed
McElroy, SL, Keck, PE Jr, Pope, HG Jr, Hudson, JI, Faedda, GL, Swann, AC. Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania. Am J Psychiatry 1992; 149(12):1633–44.Google ScholarPubMed
McElroy, SL, Strakowski, SM, Keck Jr, PE, Tugrul, KL, West, SA, Lonczak, HS. Differences and similarities in mixed and pure mania. Comprehensive Psychiatry 1995;36(3):187–94.CrossRefGoogle ScholarPubMed
Nurnberger, JI, Blehar, MC, Kaufman, CA, York-Cooler, C, Simpson, SG, Harkavy-Freedman, J, et al.Diagnostic interview for genetic studies. Arch Gen Psychiatry 1994;51:849–64.CrossRefGoogle ScholarPubMed
Perugi, G,Akiskal, HS, Micheli, C, Musetti, L, Paiano, A, Quilici, C, et al.Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases. J Affective Dis 1997;43:169–80.CrossRefGoogle ScholarPubMed
Post, RM, Rubinow, DR, Uhdet, TW, Roy-Byrne, PP, Linnoila, M, Rosoff, A, et al.Dysphoric mania. Clinical and biological correlates. Arch Gen Psychiatry 1989;46:353–8.CrossRefGoogle ScholarPubMed
Prien, RF, Himmelhoch, JM, Kupfer, DJ. Treatment of mixed mania. J Affective Dis 1988;15:915.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.
38
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Emotional hyper-reactivity as a fundamental mood characteristic of manic and mixed states
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Emotional hyper-reactivity as a fundamental mood characteristic of manic and mixed states
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Emotional hyper-reactivity as a fundamental mood characteristic of manic and mixed states
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *