title: Emotional hyper-reactivity as a fundamental mood characteristic of manic and mixed states.
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.
authors.affiliation: Service de Psychiatrie Adulte, Centre Hospitalier Charles Perrens, 121, rue de la Béchade, 33076 Bordeaux, France. chantal.henry@bordeaux.inserm.fr
authors.forename: Chantal
authors.initials: C
authors.lastname: Henry
authors.forename: Joel
authors.initials: J
authors.lastname: Swendsen
authors.forename: Donatienne
authors.initials: D
authors.lastname: Van den Bulke
authors.forename: Frederic
authors.initials: F
authors.lastname: Sorbara
authors.forename: Jacques
authors.initials: J
authors.lastname: Demotes-Mainard
authors.forename: Marion
authors.initials: M
authors.lastname: Leboyer
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012494:Sampling Studies; D012720:Severity of Illness Index