title: Clinical characteristics and temperament influences on 'happy' euphoric and 'snappy' irritable bipolar hypo/manic mood states.
abstract: BACKGROUND
  While mood elevation and euphoria are the most commonly described phenotypic descriptors of hypo/mania, irritability and anger may dominate. This study was designed to pursue possible determinants of such differing states.
  
  
  METHODS
  Patients with bipolar I or II disorder were assigned to an 'irritable/snappy' or 'euphoric/happy' sub-set on the basis of their dominant hypo/manic symptoms. Group differences were examined across clinical, personality, lifestyle and illness impact measures.
  
  
  RESULTS
  The two sub-sets did not differ on age of depression onset, family history of mood disorders, or depression severity and impairment. The snappy sub-set reported higher levels of irritability in depressed phases and were more likely to have a comorbid anxiety disorder. Their hypo/manic episodes were shorter and they were more likely to be hospitalized at such times. On a temperament measure they scored as more irritable and self-focussed and as less cooperative and effective - indicative of higher levels of disordered personality functioning.
  
  
  CONCLUSIONS
  Some comparison analyses were undertaken on a reduced sample size, giving rise to power issues. Our bipolar I and II diagnoses deviated to some extent from DSM-5 criteria in not imposing duration criteria for hypo/manic episodes.
  
  
  CONCLUSIONS
  Findings support a spectrum model for the bipolar disorders linking temperament to bipolar symptomatic state and which may have treatment implications.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, Sydney, NSW 2031, Australia.
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Graham
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, Sydney, NSW 2031, Australia. Electronic address: g.parker@unsw.edu.au.
authors.forename: Gordon B
authors.initials: GB
authors.lastname: Parker
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, Sydney, NSW 2031, Australia; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Breakspear
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, Sydney, NSW 2031, Australia.
authors.forename: Philip B
authors.initials: PB
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D001008:Anxiety Disorders / Q000453:epidemiology; D001714:Bipolar Disorder / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D003866:Depressive Disorder / Q000453:epidemiology; D005059:Euphoria; D005260:Female; D006240:Happiness; D006801:Humans; D007508:Irritable Mood; D008297:Male; D008875:Middle Aged; D010551:Personality; D010554:Personality Disorders / Q000453:epidemiology / Q000523:psychology; D013694:Temperament
keywords: Bipolar disorder; Hypomania; Mania; Temperament