Abstract
BackgroundThe boundaries between mood states in bipolar disorders are not clear when they are associated with mixed characteristics. This leads to some confusion to define appropriate therapeutic strategies. A dimensional approach might help to better define bipolar moods states and more specifically those with mixed features.Therefore, we proposed a new tool based on a dimensional approach, built with a priori five sub-scales and focus on emotional reactivity rather than exclusively on mood tonality. This study was designed to validate this MAThyS Scale (Multidimensional Assessment of Thymic States).MethodsOne hundred and ninety six subjects were included: 44 controls and 152 bipolar patients in various states: euthymic, manic or depressed. The MAThyS is a visual analogic scale consisting of 20 items. These items corresponded to five quantitative dimensions ranging from inhibition to excitation: emotional reactivity, thought processes, psychomotor function, motivation and sensory perception. They were selected as they represent clinically relevant quantitative traits.ResultsConfirmatory analyses demonstrated a good validity for this scale, and a good internal consistency (Cronbach's alpha coefficient = 0.95). The MathyS scale is moderately correlated of both the MADRS scale (depressive score; r = -0.45) and the MAS scale (manic score; r = 0.56).When considering the Kaiser-Guttman rule and the scree plot, our model of 5 factors seems to be valid. The four first factors have an eigenvalue greater than 1.0 and the eigenvalue of the factor five is 0.97. In the scree plot, the "elbow", or the point at which the curve bends, indicates 5 factors to extract. This 5 factors structure explains 68 per cent of variance.ConclusionThe characterisation of bipolar mood states based on a global score assessing inhibition/activation process (total score of the MATHyS) associated with descriptive analysis on sub-scores such as emotional reactivity (rather than the classical opposition euphoria/sadness) can be useful to better understand the broad spectrum of mixed states.
Highlights
The boundaries between mood states in bipolar disorders are not clear when they are associated with mixed characteristics
The characterisation of bipolar mood states based on a global score assessing inhibition/activation process associated with descriptive analysis on sub-scores such as emotional reactivity can be useful to better understand the broad spectrum of mixed states
Apart from the classical syndromes characterizing euphoric mania and melancholic depression, recent literature has pointed to alternative mood states associating both manic and depressive symptoms. This resulted in the definition of various syndromes including mixed states, dysphoric mania [1], agitated depression [2], depressive mixed state [3,4] and more recently mixed hypomania [5,6]
Summary
The boundaries between mood states in bipolar disorders are not clear when they are associated with mixed characteristics This leads to some confusion to define appropriate therapeutic strategies. With a very modern point of view, Kraepelin [9] defined mood states as originating from the excitement or inhibition of the three domains of the psyche: cognitive processes (train of thought rather than its contents), mood, and volition (expressed in psychomotor activity) We have extended this notion, by replacing mood tone (euphoria vs sadness) by emotional reactivity (hyporeactive vs hyperreactive), which is closer to the concept of dimensions, and because it may be considered as a quantitative symptom.
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