title: Evidence for three distinct classes of 'typical', 'psychotic' and 'dual' mania: results from the EMBLEM study.
abstract: 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.
authors.affiliation: Sant Joan De Deu-SSM, Fundació Sant Joan de Déu, St. Boi de Llobregat, Barcelona, Spain. jmharo@comb.es
authors.forename: J M
authors.initials: JM
authors.lastname: Haro
authors.forename: J
authors.initials: J
authors.lastname: van Os
authors.forename: E
authors.initials: E
authors.lastname: Vieta
authors.forename: C
authors.initials: C
authors.lastname: Reed
authors.forename: M
authors.initials: M
authors.lastname: Lorenzo
authors.forename: I
authors.initials: I
authors.lastname: Goetz
mesh_terms: 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
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine