title: Phenomenological subtypes of mania and their relationships with substance use disorders.
abstract: OBJECTIVE
  The aim of the present study was to determine the distinct clusters of subtypes among patients with bipolar disorder (BD) and the relationship between the clinical features of BD patients, particularly substance use disorders (SUDs) and the clusters.
  
  
  METHODS
  The present study initially assessed 96 inpatients who were hospitalized in the psychiatric clinic of Bakırköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology, for a BD manic episode. All patients were evaluated during the initial 3 days of their admission using the Young Mania Rating Scale (YMRS), the Montgomery-Asberg Depression Rating Scale (MADRS),the Scale for the Assessment of Positive Symptoms (SAPS), the Michigan Alcoholism Screening Test (MAST) and a sociodemographic questionnaire. The factor structures of the psychopathological scale items were determined with factor analyses and based on the factor loadings, cluster analyses were performed. The relationships among the clusters and the clinical variables were then evaluated.
  
  
  RESULTS
  The factor analyses generated three factors: increased psychomotor activity, dysphoria, and psychosis. A hierarchical cluster analysis was applied to the three factor loadings, and revealed that factor 1 (increased psychomotor activity) was high in cluster 1 and that the effects of factors 2 (dysphoria) and 3 (psychosis) were high in cluster 2. Within cluster 1 (Psychomotor elevation), 39% of patients were diagnosed with an alcohol use disorder while 31.6% of patients in the cluster 2 (dysphoric-psychotic) were diagnosed with both alcohol and cannabis use disorders. Within cluster 2 (dysphoric-psychotic), 47.4% of patients had one suicide attempt and 21.1% of patients had two or more attempts during their lifetime.
  
  
  CONCLUSIONS
  There was a significant difference in the presence of SUDs between patients with psychomotor elevation and patients in dysphoric-psychotic cluster. This may be point out that pure manic patients with BD self-medicate using the sedative effects of alcohol and the causal relationship between cannabis and psychosis. Using a dimensional approach to study BD may enhance detection of the biological correlates of BD and improve the treatment and outcomes of the disorder.
authors.affiliation: Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, İstanbul, Turkey. Electronic address: oyaguclug@yahoo.com.
authors.forename: Oya
authors.initials: O
authors.lastname: Güclü
authors.affiliation: Department of Psychiatry, School of Medicine, Bülent Ecevit University, Zonguldak, Turkey.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Şenormancı
authors.affiliation: Bahçelievler State Hospital Psychiatry, İstanbul, Turkey.
authors.forename: Erkan
authors.initials: E
authors.lastname: Aydın
authors.affiliation: Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, İstanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Erkıran
authors.affiliation: Department of Statistics, School of Medicine, Bülent Ecevit University, Zonguldak, Turkey.
authors.forename: Firuzan
authors.initials: F
authors.lastname: Köktürk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000145:classification* / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D016000:Cluster Analysis; D005163:Factor Analysis, Statistical; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology; D055815:Young Adult
keywords: Bipolar disorder; Cluster analysis; Substance use disorder