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The symptom structure of bipolar acute episodes: In search for the mixing link

Lookup NU author(s): Emeritus Professor Jan Scott


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Objective: The nature of mixed mood episodes is still a matter of controversy amongst experts. Currently, the approach to this syndrome is mainly categorical and very restrictive. The factor-structure of bipolar mood episodes has not been studied yet. We performed a dimensional analysis of the structure of bipolar episodes aimed at identifying a factor deconstructing mixed episodes; furthermore, we analyzed correlations of factors emerging from the factorial analysis of the Brief Psychiatric Rating Scale (BPRS) with Temperament Evaluation of Memphis-Pisa-Paris-San Diego (TEMPS-A) and predominant polarity.Method: 187 consecutive bipolar I inpatients hospitalized for DSM-IV-TR acute mood episodes (depressive, manic or mixed) underwent a standardized assessment, including the 24-item Brief Psychiatric Rating Scale (BPRS 4.0), the 21-item Hamilton Depression Rating Scale (HDRS-21), the Young Mania Rating Scale (YMRS) and the TEMPS-A. Principal factor analysis was performed on BPRS-24 items.Results: This analysis revealed five factors corresponding to "psychosis", "euphoric mania", "mixity", "dysphoria" and "inhibited depression", capturing 71.89% of the rotated variance. The mixity factor was characterized by higher rates of suicidal ideation, more mixed episodes, higher frequencies of antidepressant (AD) use, depressive predominant polarity and anxious temperament.Discussion: The factor-structure of the BPRS in inpatients with bipolar I disorder with an acute episode of any type is pentafactorial; one factor identified is the mixity factor, which is independent from other factors and characterized by anxiety and motor hyperactivity and by the absence of motor retardation. Our results should prompt reconsideration of proposals for DSM-5 diagnostic criteria for the mixed features specifier. Limitations of the study include the relative small sample, the absence of drug-naive patients and the use of rating scales no specific for mixed states. (C) 2013 Elsevier B.V. All rights reserved.

Publication metadata

Author(s): Pacchiarotti I, Nivoli AMA, Mazzarini L, Kotzalidis GD, Sani G, Koukopoulos A, Scott J, Strejilevich S, Sanchez-Moreno J, Murru A, Valenti M, Girardi P, Vieta E, Colom F

Publication type: Article

Publication status: Published

Journal: Journal of Affective Disorders

Year: 2013

Volume: 149

Issue: 1-3

Pages: 56-66

Print publication date: 01/07/2013

Online publication date: 07/02/2013

ISSN (print): 0165-0327

Publisher: Elsevier


DOI: 10.1016/j.jad.2013.01.003


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Funder referenceFunder name
Fondo Europeo de Desarrollo Regional. Union Europea
Spanish Ministry of Science and Innovation
Instituto de Salud Carlos III
Spanish Ministry of Economy and Competitiveness
Spanish Ministry of Economy and Competitivity
(PS09/01044) PN 2008-2011Instituto de Salud Carlos III- Subdireccion General de Evaluacion y Fomento de la Investigacion
2009 SGR 1022Comissionat per a Universitats i Recerca del DIUE de la Generalitat de Catalunya
CP08/00140Instituto Carlos III
CM11/00163Instituto de Salud Carlos III