Caractérisation de la manie dans la cohorte nationale de 1 090 patients de l’étude « EPIMAN-II-Mille » : fréquence des sous-types cliniques, début et errances diagnostiques

Abstract

Background. – Based on the data of a prior epidemio-clinical study, EPIMAN, in which 104 subjects hospitalized for acute mania were included, a new multi-site study was initiated with the objective to replicate the obtained data from EPIMAN and to thrive them through a more complete assessment of psychotic and anxious features associated with mania. Method. – “EPIMAN-II-Mille” is a national collaborative study, which involved training 317 French psychiatrists working in different sites representative of France. The study already succeeded in including 1 090 cases hospitalized for acute mania belonging to primary bipolar disorder (DSM-IV criteria). At inclusion, the psychometric assessment was made by using Mania Rating Scale (MRS) and the Beigel-Murphy Scale (MSRS), a checklist of depressive symptoms (McElroy et al. as modified by Akiskal et al.) and MADRS for intensity of depression, the SAPS of Andreasen for psychotic features, and the multiple visual analog scales of bipolarity (Ahearn and Carroll) for self-rating. An agenda for mood stability was filled out three times daily during the first week of hospitalization, separately by nursing staff and patients. After acute mania abated the full self-rated version of affective temperament (Hantouche et al.), was filled out by patients, and the anxious comorbidity explored by searching for DSM-IV criteria for all anxiety disorders and by using the AMDP-AT scale (Bobon). Results. – They confirmed the high rate of psychotic mania (33,4 % with MCP, mood-congruent psychotic features, and 16,5 % with MIP, mood-incongruent psychotic features) and mixed depressive mania (30 %). These clinical sub-types of mania were characterized by high frequency of diagnostic errors, toward schizophrenia for MIP, and toward anxiety and personality disorders for mixed mania. Female over-representation was observed in both mixed and MIP mania sub-groups (respectively 65 % and 67 %). Psychotic mania (MCP + MIP) seemed to be prevalent in younger patients, not married, presenting a substance abuse (other than alcohol). Mixed depressive mania (as defined by the presence of two or more depressive symptoms) was characterized by a mixed polarity of first episodes (22 % versus 7 % in pure mania), especially by higher rate of recurrence (7,5 versus 6,8 episodes), and suicide attempts (46,4 % versus 29,1 %), and more consumption of antidepressants and anxiolytics during the last six months prior to admission. Certain overlapping similarities were observed between psychotic and missed sub-types of mania. Beside female over-representation, MIP sub-group showed higher score on MADRS (when compared to non psychotic mania) and mixed sub-group presented higher rate of MIP (21,8 % versus 14,2 % in pure euphoric mania) and augmented scores on delusions (9,4 versus 7,7) and hallucination (2,7 versus 1,8) items of the SAPS. Conclusion. – The first data deriving from this largest study ever conducted suggested that acute mania belongs to a rich phenotype spectrum, in which psychotic and / or mixed forms are not easily recognized, and adequate treatments initiated with long delays. A correct appraisal of the different sub-types of acute mania seems to be warranted in clinical practice.