Signs and symptoms of mania in pure and mixed episodes

BACKGROUND: Debate continues about the diagnosis of mixed mania and the restrictiveness of the DSM-III-R and DSM-IV criteria for Bipolar Disorder, mixed. Although awareness of dysphoric features during mania continues to grow, standard mania rating instruments do not adequately assess mixed states and there is a striking disparity between the dysphoric signs and symptoms emphasized in research studies and the commonly employed DSM criteria. METHODS: Three hundred sixteen inpatients meeting DSM-III-R criteria for Bipolar Disorder, manic or mixed, were evaluated by rating 20 signs and symptoms. The frequencies of these signs and symptoms were computed for both diagnostic subtypes and compared using chi2 statistics and conditional probability parameters. RESULTS: The most frequently noted signs and symptoms in mania are motor activation, accelerated thought process, pressured speech and decreased sleep. Although euphoric mood was present in a large portion of the cohort, irritability, dysphoric mood and mood lability were also prominent in the entire cohort. Dysphoric mood, mood lability, anxiety, guilt, suicidality, and irritability were the only symptoms significantly more common in the mixed group. In contrast, grandiosity, euphoric mood, and pressured speech were significantly more often observed in the pure manic group. Contrary to popular belief, paranoia did not differ significantly between the two groups. Suicidality was present in a non-trivial 7% of the entire cohort, including some subjects who did not meet the criteria for mixed mania. LIMITATIONS: The comparison of mixed and manic episodes requires the appropriate definition of mixed states. In the current report we use the DSM-III-R definition of Bipolar Disorder, mixed, which may be too rigid. CONCLUSIONS: The data underscore that mania is not a purely euphoric state. Substantial rates of dysphoria, lability, anxiety and irritability were noted in the "pure" manic patients, as well as in those who meet the full DSM criteria for Bipolar Disorder, mixed, suggesting, that perhaps a less restrictive definition of mixed states would be more appropriate.     

Relationship between formal thought disorder and retardation in schizophrenia.

17 schizophrenics admitted into the hospital less than 6 mo before were compared on Bannister's Grid Test of Schizophrenic Thought Disorder with 19 schizophrenics admitted over 6 mo before and with a group of 17 nonschizophrenic, psychiatric controls under 3 conditions: fast rate of responding, slow rate of responding, and in-between rate of responding. It was predicted that the schizophrenics would show more thought disorder under fast than slow conditions and that the recently admitted schizophrenics would be more thought disordered than the earlier admitted schizophrenics. Contrary to expectations, the patients tended to show less thought disorder on the test when their responses were speeded than when they were encouraged to take their time. Moreover, the earlier admitted schizophrenics showed more thought disorder than the recently admitted schizophrenics under all 3 conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability of formal thought disorder and referential communication disturbances in schizophrenia.

This study examined the degree to which different types of communication disturbances in the speech of 48 schizophrenia patients and 28 controls were variable and state related versus stable and traitlike. Clinically rated formal thought disorder and 5 types of referential disturbance showed substantial stability within participants over time. The sixth type of referential disturbance, the vague reference, was not stable over time. Formal thought disorder was associated with the severity of core psychotic symptoms in patients, whereas referential disturbances showed little or no association with positive or negative symptom severity. Furthermore, changes in psychotic symptoms over time were accompanied by corresponding changes in formal thought disorder but not referential disturbances. These results support the idea that some types of referential disturbances are traitlike and may be reflective of vulnerability as well as manifest illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lexical cohesion and formal thought disorder during and after psychotic episodes.

Compared speech samples obtained from 10 schizophrenics (mean age 28 yrs), 11 manics (mean age 26.2 yrs), 11 schizoaffectives (mean age 25.8 yrs), and 10 normals (mean age 33.6 yrs) for the amount of lexical cohesion both within and between clauses. Two speech samples were obtained for each patient: one shortly after admission to a psychiatric hospital and another several weeks following discharge. All psychiatric patients showed evidence of formal thought disorder at admission, and all 3 groups showed a significant decline in the extent of thought disorder at follow-up. There were no differences between groups with regard to between-clause lexical cohesion at either point in time. Within-clause lexical cohesion did distinguish among the psychiatric groups at the 1st assessment interval; schizophrenics showed less within-clause lexical cohesion than the manics or schizoaffective patients. The manics and the schizoaffectives showed a significant decline in the amount of within-clause lexical cohesion from initial assessment to follow-up. The schizophrenics exhibited a modest decline in the amount of between-clause lexical cohesion. Results indicate that diagnostic differences in lexical cohesion depended on the specificity of the measure and suggest that there are subtle differences between the forms of verbal-communication impairment observed in schizophrenic and affective disorders. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of formal thought disorder to the communication deficit in schizophrenics.

Evaluated 40 schizophrenics and 20 normals on a social communication task and on an individual cognitive task, both designed to reveal decentering deficits. It was hypothesized that the processes underlying the schizophrenic's thought disorder are formally similar to the processes involved in his deviant organization of social situations, specifically social communication, with both deficits to be interpreted in terms of faulty decentering. Schizophrenics manifested a decentering deficit on both the social communication (p     

Cognitive impairments associated with formal thought disorder in people with schizophrenia.

Formal thought disorder (FTD), or disorganized speech, is one of the central signs of schizophrenia. Despite extensive research, the cognitive processes associated with FTD are still unclear. However, the authors' review of FTD theories and research indicates that considerable progress has been made in identifying possible cognitive impairments associated with FTD. Specifically, FTD is strongly associated with impaired executive functioning and with impaired processing of semantic information. Their review indicates that previous research has not yet supported an association between FTD and either an increase in spreading activation or an impairment within the language production system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between formal thought disorder and executive functioning component processes.

In 2 studies, associations between formal thought disorder (FTD) and 2 components of executive functioning, processing of context and interference resolution, were investigated. One study, involving people with schizophrenia, examined associations between performance on processing of context (N-back) and interference resolution (interference in Steinberg probe recognition) tasks and FTD. The second study, involving nonpsychiatric participants, was an analogue study that examined the effects of simulated processing of context (performance of 1-back with distraction) and interference resolution (telling new stories about previously seen pictures) deficits on FTD in a speech production task. In both studies, processing of context deficits predicted FTD. Moreover, in both studies, the effect of processing of context deficits on FTD was especially pronounced when combined with interference resolution deficits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Level of formal thought and organizational memory strategies.

Identified 28 9th graders of similar intelligence as being in either early or late formal-operational stages and presented them with tasks to assess their use of organizational memory strategies: multitrial free recall of unrelated and categorized words and a sorting task followed by free recall of the sorted words. In the multitrial free-recall tasks, late formal-operational adolescents generally showed greater amounts of recall organization than did early formal-operational adolescents. When storage organization was induced through sorting, however, the 2 groups showed equivalent recall organization. Across tasks, late formal-operational adolescents' recall exceeded that of early formal-operational adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Language production and thought disorder in schizophrenia.

The authors examined the relationship between language production (LP) processes and thought disorder. Thirty-nine schizophrenic or schizoaffective participants completed tasks measuring discourse planning, monitoring, and grammatical–phonological encoding, as well as an interview used to rate thought disorder. The authors found that different LP processes were differentially related to different thought disorder subtypes. Incompetent references were strongly and selectively related to discourse planning performance. In addition, word approximations–neologisms were strongly and specifically associated with grammatical–phonological encoding performance. The article concludes with a discussion of the implications of these results for understanding the multifaceted nature and etiology of thought disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Left-handedness and thought disorder in the schizophrenias.

The relation between language dysfunction and handedness was examined in a sample of 58 male schizophrenic patients. Severity and type of language dysfunction were assessed using ratings on categories of thought disorder derived from the Schedule of Affective Disorders and Schizophrenia (Spitzer & Endicott, 1977). Hand preferred for writing was the criterion for handedness. In this sample, the incidence of left-handedness was raised and left-handedness was associated with the presence and severity of thought disorder. These findings are congruent with the hypothesis that a sizable proportion of left-handed schizophrenic individuals are left-handed because of a disruption in the pattern of hemispheric dominance that also impairs language functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual differences in formal thought: Role of expectations and aptitudes.

The present investigation of individual differences in formal reasoning focused on expectation-based rules governing formal reasoning performance and the relationship between aptitudes considered important in formal reasoning and formal-reasoning performance. 60 17-yr-old high school seniors received a battery of group and individual aptitude measures and formal-reasoning tests. Results reveal the effect of expectation-based rules on formal-reasoning performance. The aptitude measures overlapped substantially with formal reasoning, although 12% of the formal-reasoning variance was unique. A newly defined aspect of field dependence–independence, that is, familiar field, related to formal reasoning and clarified individual differences in formal reasoning. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Formal thought disorder in schizophrenics and their twins.

Measured thought disorder in the co-twins of schizophrenic twins in 17 pairs of identical twins, 14 pairs of fraternal same-sex twins, and 12 unpaired twins. Ss were administered a modified version of the Scale for the Assessment of Thought, Language, and Communication Disorders. No evidence of genetic influence on thought disorder was found. A factor analysis of the thought disorder scales revealed 2 interpretable factors reflecting verbosity and discontinuities in the form of speech. Scales with high loadings on the verbosity factor showed signs of familial influence and were significantly correlated with severity of psychiatric history. Scales with high loadings on the discontinuity factor were associated with the florid psychotic phase of illness. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention and memory dysfunction in posttraumatic stress disorder.

Attention and memory performances were studied in Persian Gulf War veterans with and without posttraumatic stress disorder (PTSD) diagnoses. Veterans diagnosed with PTSD showed relative performance deficiencies on tasks of sustained attention, mental manipulation, initial acquisition of information, and retroactive interference. Their performances were also characterized by errors of commission and intrusion. The tendency toward response disinhibition and intrusion on cognitive tasks was correlated positively with re-experiencing symptoms and negatively with avoidance-numbing symptoms. These cognitive deficit patterns are consistent with models of PTSD that emphasize the role of hyperarousal and implicate dysfunction of frontal-subcortical systems. Results suggest that intrusion of traumatic memories in PTSD may not be limited to trauma-related cognitions but instead reflects a more general pattern of disinhibition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life events as predictors of mania and depression in bipolar I disorder.

[Correction Notice: An erratum for this article was reported in Vol 117(3) of Journal of Abnormal Psychology (see record 2008-11014-022). In the aforementioned article, Amy K. Cuellar's last name was misspelled. The corrected list of author names is: Sheri L. Johnson, Amy K. Cuellar, Camilo Ruggero, Carol Winett-Perlman, Paul Goodnick, Richard White, and Ivan Miller.] To date, few prospective studies of life events and bipolar disorder are available, and even fewer have separately examined the role of life events in depression and mania. The goal of this study was to prospectively examine the role of negative and goal-attainment life events as predictors of the course of bipolar disorder. One hundred twenty-five individuals with bipolar I disorder were interviewed monthly for an average of 27 months. Negative and goal-attainment life events were assessed with the Life Events and Difficulties Schedule. Changes in symptoms were evaluated using the Modified Hamilton Rating Scale for Depression and the Bech-Rafaelsen Mania Scale. The clearest results were obtained for goal-attainment life events, which predicted increases in manic symptoms over time. Negative life events predicted increases in depressive symptoms within regression models but were not predictive within multilevel modeling of changes in depressive symptoms. Given different patterns for goal attainment and negative life events, it appears important to consider specific forms of life events in models of bipolar disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conduct disorder with and without mania in a referred sample of ADHD children

OBJECTIVE: To test the hypothesis that dysphoric and non-dysphoric types of CD could be distinguished from one another in their patterns of familiality, adversity, and comorbidity. METHODS: We examined 140 ADHD and 120 normal controls at baseline and 4 years later using assessments from multiple domains. We compared ADHD subgroups with and without conduct (CD) and bipolar (BPD) disorders on psychiatric outcomes at a 4-year follow-up, familial psychopathology and psychosocial functioning. RESULTS: We found that ADHD children with both disorders had higher familial and personal risk for mood disorders than those with CD only, who had a higher personal risk for antisocial personality disorder. Among ADHD probands, having both CD and BPD was associated with poorer functioning and an increased risk for psychiatric hospitalization. DISCUSSION: Although preliminary, our findings suggest that the distinction between dysphoric and non-dysphoric CD may be clinically meaningful. If confirmed, our findings could have important diagnostic and therapeutic implications for the management of antisocial youth.     

Positive thought disorder in a hypothetically psychosis-prone population.

Proverb interpretations of subjects who scored high on the Perceptual Aberration-Magical Ideation Scale (Per-Mags) (Chapman & Chapman, 1985) were compared with those of low-scoring controls. Responses to 10 familiar and 3 unfamiliar proverbs were scored for Bizarre-idiosyncratic thinking (J. Marengo et al; see record 1987-30079-001) and literalness (C. A. Hertler et al; see record 1979-12346-001). A Group by Type of Proverb (familiar versus unfamiliar) interaction was found for bizarre-idiosyncratic scores; Per-Mags scored higher than controls on unfamiliar, but not familiar proverbs. The Group?×?Familiarity interaction for bizarre-idiosyncratic scores indicates that the Per-Mag group displayed a subclinical, positive-thought disorder that is affected by the familiarity of the proverbs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association of recurrent suicidal ideation with nonremission from acute mixed mania

OBJECTIVE: The authors' goal was to examine suicidality in relation to acute symptom remission in inpatients with mixed and pure bipolar disorder. METHOD: Using chart review of 184 adult inpatients with bipolar I disorder, the authors assessed patients' past and current suicidality, other psychopathology, treatment, and remission. RESULTS: Past, current, and recurrent suicidality were significantly more common among patients with mixed mania than among those with pure mania. The probability of remission declined by 49% for every suicide attempt made before the index manic episode. Mixed mania, multiple previous hospitalizations, and previous suicide attempts were significantly associated with current suicidality. CONCLUSIONS: Suicidality is linked with mixed manic states and may be a clinical marker for recurrent dysphoric mania. Multiple suicide attempts are associated with nonremission from mixed manic episodes.     

Ego boundary impairment and thought disorder in frequent nightmare sufferers.

This investigation examined the proposed relationship between nightmare frequency and ego boundary impairment (Hartmann, 1984) in a sample of female college students. Thirty frequent nightmare sufferers (at least one attack per week) and 30 controls (maximum of one nightmare per year) were compared. In order to measure ego boundary impairment, the Rorschach inkblot test was administered and scored for barrier and penetration responses (Fisher & Cleveland, 1968) and indices of thought disorder (Blatt & Ritzler, 1974). An ego boundary questionnaire developed by Hartmann and colleagues (Hartmann, 1989; Hartmann et al., 1987) was also administered. Although barrier and penetration scores did not discriminate, the frequent-nightmare subjects demonstrated more disordered thinking on the Rorschach (p