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. 2007 May;9(3):206-12.
doi: 10.1111/j.1399-5618.2007.00357.x.

Manic Symptoms and Impulsivity During Bipolar Depressive Episodes

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Free PMC article

Manic Symptoms and Impulsivity During Bipolar Depressive Episodes

Alan C Swann et al. Bipolar Disord. .
Free PMC article

Abstract

Objectives: In contrast to the extensive literature on the frequent occurrence of depressive symptoms in manic patients, there is little information about manic symptoms in bipolar depressions. Impulsivity is a prominent component of the manic syndrome, so manic features during depressive syndromes may be associated with impulsivity and its consequences, including increased risk of substance abuse and suicidal behavior. Therefore, we investigated the prevalence of manic symptoms and their relationships to impulsivity and clinical characteristics in patients with bipolar depressive episodes.

Methods: In 56 bipolar I or II depressed subjects, we investigated the presence of manic symptoms, using Mania Rating Scale (MRS) scores from the Schedule for Affective Disorders and Schizophrenia (SADS), and examined its association with other psychiatric symptoms (depression, anxiety, and psychosis), age of onset, history of alcohol and/or other substance abuse and of suicidal behavior, and measures of impulsivity.

Results: MRS ranged from 0 to 29 (25th-75th percentile, range 4-13), and correlated significantly with anxiety and psychosis, but not with depression, suggesting the superimposition of a separate psychopathological mechanism. Impulsivity and history of substance abuse, head trauma, or suicide attempt increased with increasing MRS. Receiver-operating curve analysis showed that MRS could divide patients into two groups based on history of alcohol abuse and suicide attempt, with an inflection point corresponding to an MRS score of 6.

Discussion: Even modest manic symptoms during bipolar depressive episodes were associated with greater impulsivity, and with histories of alcohol abuse and suicide attempts. Manic symptoms during depressive episodes suggest the presence of a potentially dangerous combination of depression and impulsivity.

Conflict of interest statement

The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

Figures

Fig. 1
Fig. 1
Distribution of Schedule for Affective Disorders and Schizophrenia Mania Rating Scale (MRS) scores in subjects with bipolar depression.
Fig 2
Fig 2
Fisher’s Exact Test (FET) for comparison of depressed subjects above versus below each MRS score. The comparison becomes significant for ethanol abuse and for head trauma at MRS > 7 (with 27 subjects scoring lower and 29 higher), and for suicide attempt at MRS > 8 (with 30 subjects lower and 26 higher).
Fig 3
Fig 3
Effect sizes for comparisons of impulsivity measures in bipolar depression as a function of Mania Rating Scale (MRS) score. The graph shows effect size for comparing those above versus below each MRS score. The Immediate Memory Task (IMT) measures required MRS scores of about 8 to reach moderate effect sizes, while the Barratt Impulsiveness Scale (BIS) total score had a comparable effect size at a MRS of only 3 or 4 (at MRS > 3, 12 subjects scored lower and 44 higher). CE = commission errors; CD = correct detections.
Fig 4
Fig 4
Receiver operating characteristic curve for Mania Rating Scale (MRS) as a predictor of having history of alcohol abuse and suicide attempt. As described in the text, area under the curve = 0.72, and the inflection point occurred at the point corresponding to MRS = 6, where sensitivity = 0.85 and specificity = 0.55. The dashed line shows the curve for least squares fitting to a quadratic equation.

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