Response and remission in adolescent mania: signal detection analyses of the young mania rating scale.
OBJECTIVE
The purpose of this study was to determine optimal criteria for defining response and remission in adolescents with acute mania.


METHODS
Data were analyzed from three treatment studies of adolescents with acute mania (N = 99). Trained raters completed the Young Mania Rating Scale (YMRS), and clinicians completed the Clinical Global Impressions Scale for Bipolar Disorder (CGI-BP) independent of YMRS ratings. For response, the percentages of reduction in YMRS scores from baseline to endpoint were compared with CGI-BP Mania Improvement scores. For remission, endpoint YMRS scores were compared with CGI-BP Mania Severity scores. Signal detection analyses were conducted to evaluate the efficiency of selected cutoffs associated with response and remission.


RESULTS
A > or =55% reduction in YMRS scores from baseline to endpoint was the optimal cutoff defining response. An absolute endpoint YMRS score < or =12 was the optimal cutoff defining remission.


CONCLUSIONS
The results of this signal detection analysis in adolescent mania suggest that current commonly used cutoffs to define response (> or =50% reduction) and remission (< or =12) may be appropriate with regard to efficiency. Studies with methods specifically tailored to evaluate and compare these rating scales and larger patient samples from multiple sites are needed to confirm these preliminary findings.
Patel
Nick C
NC
Drs. Patel, Strakowski, and DelBello are with the Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine; Drs. Patel and Patrick are with the College of Pharmacy, University of Cincinnati; and Dr. Youngstrom is with Department of Psychology, University of North Carolina at Chapel Hill. Electronic address: nick.patel@uc.edu.
Patrick
Danielle M
DM
Drs. Patel, Strakowski, and DelBello are with the Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine; Drs. Patel and Patrick are with the College of Pharmacy, University of Cincinnati; and Dr. Youngstrom is with Department of Psychology, University of North Carolina at Chapel Hill.
Youngstrom
Eric A
EA
Drs. Patel, Strakowski, and DelBello are with the Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine; Drs. Patel and Patrick are with the College of Pharmacy, University of Cincinnati; and Dr. Youngstrom is with Department of Psychology, University of North Carolina at Chapel Hill.
Strakowski
Stephen M
SM
Drs. Patel, Strakowski, and DelBello are with the Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine; Drs. Patel and Patrick are with the College of Pharmacy, University of Cincinnati; and Dr. Youngstrom is with Department of Psychology, University of North Carolina at Chapel Hill.
Delbello
Melissa P
MP
Drs. Patel, Strakowski, and DelBello are with the Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine; Drs. Patel and Patrick are with the College of Pharmacy, University of Cincinnati; and Dr. Youngstrom is with Department of Psychology, University of North Carolina at Chapel Hill.
D000208:Acute Disease; D000293:Adolescent; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D003987:Dibenzothiazepines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D000069348:Quetiapine Fumarate; D012074:Remission Induction; D012680:Sensitivity and Specificity; D017603:Signal Detection, Psychological; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*
D018692:Antimanic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate; D014635:Valproic Acid