Evidence for three distinct classes of 'typical', 'psychotic' and 'dual' mania: results from the EMBLEM study.
OBJECTIVE
To describe patients included in the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study and to assess and clinically validate the presence of clinical subtypes of patients with acute mania.


METHODS
The EMBLEM study is a 2-year prospective, observational study on the treatment and outcome of patients who are treated for a manic or mixed episode. Latent Class Analysis was used to define discrete groups of patients at baseline.


RESULTS
Three groups were identified: 'typical mania' (59% of patients); 'psychotic mania' (27%) with more severe mania and presence of psychotic symptoms; and 'dual mania' (13%) with a high proportion of substance abuse. Patient groups differed in age of onset, social functioning and service needs.


CONCLUSIONS
Dual mania represents a distinct and not infrequent subgroup of patients with mania. The exclusion of patients with comorbid substance problems from clinical trials creates a gap in our knowledge on treatment effectiveness.
Haro
J M
JM
Sant Joan De Deu-SSM, Fundació Sant Joan de Déu, St. Boi de Llobregat, Barcelona, Spain. jmharo@comb.es
van Os
J
J
Vieta
E
E
Reed
C
C
Lorenzo
M
M
Goetz
I
I
D000328:Adult; D000553:Ambulatory Care; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000145:classification* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D004359:Drug Therapy, Combination; D005060:Europe; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D010343:Patient Admission; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000145:classification* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D016896:Treatment Outcome
D018692:Antimanic Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine