ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Defining threshold and exploring dimensionality of co-existing depression in acute Mania: Data on 1090 patients “EPIMAN-II”


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ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Defining threshold and exploring dimensionality of co-existing depression in acute Mania: Data on 1090 patients “EPIMAN-II”

Vol 1 - Iss 2 - Short Communication - Defining threshold and exploring dimensionality of co-existing depression in acute Mania: Data on 1090 patients “EPIMAN-II” #24

Defining threshold and exploring dimensionality of co-existing depression in acute Mania: Data on 1090 patients “EPIMAN-II” Hantouche EG1, Akiskal HS2, Azorin JM3, Lancrenon S4, Châtenet-Duchêne L5 1) Mood Center, Université Paris VI, Hôpital Pitié-Salpêtrière, Paris 2) International Mood Center, UCSD, San Diego 3) Hôpital Ste Marguerite, Marseille 4) Sylia-Stat, Antony 5) CNS Department Sanofi-Synthelabo, Le Plessis Robinson - France Following EPIMAN study (Akiskal et al, 1998), a new multi-site study was implemented with the objective of including 1000 patients with acute mania. In this report, data are focused on the mixed depressive acute mania. Method: “EPIMAN-II Thousand” is a national multi-site collaborative study dedicated to the clinical sub-types of mania. It involved training 317 French psychiatrists working in different sites representative of France. The study actually succeeded in recruiting 1090 cases admitted for acute mania (DSM-IV criteria). A checklist of depressive symptoms (McElroy et al, modified by Akiskal) and the MADRS were used to assess co-existing depression. Results: In the entire population, irritability (78,6%), mood lability (62,5%), and depressed mood (35,2%) were the most frequent symptoms. The rate of mixed mania, as defined by the presence of 2 depressive symptoms or more (“lability” and “irritability” items excluded), was 30,4%. MADRS global score was 15±7 in the entire population. A modified version of MADRS (4 items excluded: “appetite”, “sleep”, “concentration”, “inner tension”) seemed to be the most sensitive to separate between pure (1,4±2) and depressive manias (9,7±5, p<0,0001). The threshold of 6 had excellent specificity (94,2%) and the best sensitivity (79,8%). A principal factor analysis conducted on the list of depressive items, separated between two dimensions: “depressed mood factor”, and “psychomotor factor”. Conclusion: In this largest study of acute mania ever conducted, depressive mixed mania concerned at least on third of acute cases. A refined version of MADRS (6 items) is suitable for dimensional assessment of co-existing depression, which turned out to be bi-dimensional: cognitive-emotional and psychomotor. Bibliography: Akiskal HS et al. Gender, temperament, and the clinical picture in dysphoric mixed mania: findings from EPIMAN study. J Affect Disord 1998; 50: 175-86. Funding source: unrestricted grant from Sanofi-Aventis

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