title: Diagnosis and characterization of mania: Quantifying increased energy and activity in the human behavioral pattern monitor.
abstract: Increased energy or activity is now an essential feature of the mania of Bipolar Disorder (BD) according to DSM-5. This study examined whether objective measures of increased energy can differentiate manic BD individuals and provide greater diagnostic accuracy compared to rating scales, extending the work of previous studies with smaller samples. We also tested the relationship between objective measures of energy and rating scales. 50 hospitalized manic BD patients were compared to healthy subjects (HCS, n=39) in the human Behavioral Pattern Monitor (hBPM) which quantifies motor activity and goal-directed behavior in an environment containing novel stimuli. Archival hBPM data from 17 schizophrenia patients were used in sensitivity and specificity analyses. Manic BD patients exhibited higher motor activity than HCS and higher novel object interactions. hBPM activity measures were not correlated with observer-rated symptoms, and hBPM activity was more sensitive in accurately classifying hospitalized BD subjects than observer ratings. Although the findings can only be generalized to inpatient populations, they suggest that increased energy, particularly specific and goal-directed exploration, is a distinguishing feature of BD mania and is best quantified by objective measures of motor activity. A better understanding is needed of the biological underpinnings of this cardinal feature.
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Perry
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: McIlwain
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Kloezeman
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
authors.forename: Brook L
authors.initials: BL
authors.lastname: Henry
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Center of Excellence for Stress and Mental Health (CESAMH), Veteran's Administration, San Diego, CA, USA. Electronic address: aminassian@ucsd.edu.
authors.forename: Arpi
authors.initials: A
authors.lastname: Minassian
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis*; D005106:Exploratory Behavior; D005260:Female; D006801:Humans; D006948:Hyperkinesis / Q000175:diagnosis* / Q000209:etiology*; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000523:psychology*; D009043:Motor Activity / Q000502:physiology*; D011569:Psychiatric Status Rating Scales
keywords: Activity; Behavioral pattern monitor; Bipolar disorder; DSM-5; Energy; Mania