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Am J Psychiatry 1992; 149:1633-1644
Copyright © 1992 by American Psychiatric Association
Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania
SL McElroy, PE Keck Jr, HG Pope Jr, JI Hudson, GL Faedda and AC Swann
Department of Psychiatry, University of Cincinnati College of Medicine, OH 45267-0559.
OBJECTIVE: The authors reviewed available evidence regarding the status of
dysphoric or mixed mania as a distinct clinical state and formulated
operational criteria for its diagnosis. METHOD: Studies of dysphoric mania
or hypomania in patients with bipolar disorder were analyzed with regard to
clinical characteristics, prevalence, demographic features, course of
illness, outcome, family history, associated conditions, biological tests,
and response to biological treatment. RESULTS: Although some studies
suggest that dysphoric and nondysphoric mania are similar conditions,
others suggest that, compared with nondysphoric mania, dysphoric mania may
be more severe; more likely to occur in women; more likely to be associated
with suicidality, a younger age at onset, a longer duration of illness,
higher rates of personal and familial depression, concomitant alcohol or
sedative-hypnotic abuse, neuropsychiatric abnormalities, and poorer
outcome; more frequently associated with cortisol nonsuppression; and less
likely to respond adequately to lithium but perhaps more likely to respond
to ECT or anticonvulsants. CONCLUSIONS: Substantial evidence suggests that
dysphoric mania may be a distinct affective state. Contrary evidence,
however, suggests that dysphoric mania may be a form of typical mania, a
stage-related or severe form of mania, or a transitional state between
mania and depression. Because the evidence may be inconsistent because of
varying definitions of dysphoric mania among studies, the authors propose
preliminary operational diagnostic criteria for the future study of
dysphoric mania.
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