Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-11T01:31:38.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Latent structure of the symptomatology of hospitalized patients with bipolar mania

Published online by Cambridge University Press:  15 April 2020

A. Filgueiras ,
A.L.S. Nunes ,
L.A.S. Silveira ,
R. de Assis da Silva ,
R.O. da Silva ,
J. Landeira-Fernandez  and
E. Cheniaux
A. Filgueiras*
Affiliation:
University of Western Ontario (UWO), Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Brazil
A.L.S. Nunes
Affiliation:
Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Brazil
L.A.S. Silveira
Affiliation:
Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Brazil
R. de Assis da Silva
Affiliation:
Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ); Instituto Philippe Pinel, Brazil
R.O. da Silva
Affiliation:
Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Brazil
J. Landeira-Fernandez
Affiliation:
Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Universidade Estácio de Sá, Brazil
E. Cheniaux
Affiliation:
Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Universidade do Estado do Rio de Janeiro (UERJ), Brazil
*
*PUC-Rio–Departamento de Psicologia, Rua Marques de São Vicente, 225/201L, 22453-900 Gávea, Rio de Janeiro, Brazil. Tel.: +55 21 3527 1185. E-mail address: albertofilgueiras@gmail.com (A. Filgueiras).
Get access

Abstract

Several studies have attempted to understand the dimensions of psychiatric symptoms in manic episodes, but only a few have been able to model the latent structure of mania in bipolar disorder patients using confirmatory factor analysis. The objective of the present study was to search for the best model of the symptomatology of hospitalized manic patients. To achieve this goal, 117 manic inpatients during a manic crisis participated in this research. Exploratory factor analysis was conducted followed by confirmatory factor analysis using an exploratory factor analysis solution and three other theory-based models. The exploratory factor analysis results revealed a six-factor structure: depression, suicide, insomnia, mania, psychosis, and anxiety. This solution also presented the best fit to the data when tested with confirmatory factor analysis. A five-factor solution, without suicide as a separate dimension, appeared to be more theoretically suitable. Another important finding was that anxiety was an independent dimension in mania. Some hypotheses are discussed in light of contemporary theories, and future studies should investigate this aspect further.

Keywords

ManiaConfirmatory factor analysisBipolar disorderLatent structure
Type
Original article
Information
European Psychiatry , Volume 29 , Issue 7 , September 2014 , pp. 431 - 436
Copyright
Copyright © 2014 Elsevier Masson SAS

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, H.S., Hantouche, E.G., Bourgeois, M.L., Azorin, J.M., Sechter, D., Allilaire, J.F.et al.Toward a refined phenomenology of mania: combining clinician-assessment and self-report in the French EPIMAN stdy. J Affect Disord 2001;67(1–3):89–96. http://www.ncbi.nlm.nih.gov/pubmed/11869755.CrossRefGoogle Scholar
Akiskal, H.S., Azorin, J.M., Hantouche, E.G.Proposed multidimensional structure of mania: beyond the euphoric-dysphoric dichotomy. J Affect Disord 2003;73(1–2):7–18. http://www.ncbi.nlm.nih.gov/pubmed/12507733.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and statistical manual of mental disorders IV TR. Text. Arlington: American Psychiatric Association; 2000.Google Scholar
American Psychiatric Association.> Diagnostic and statistical manual of mental disorders fifth edition (DSM-5™) [Internet]. Arlington: American Psychiatric Association; 2013. http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=2557.+Diagnostic+and+statistical+manual+of+mental+disorders+fifth+edition+(DSM-5™)+[Internet].+Arlington:+American+Psychiatric+Association;+2013.+http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=2557.>Google Scholar
Amorim, P.Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais. Rev Bras Psiquiatr 2000;22(3):106–115. [cited 2013 Oct 8] http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462000000300003&lng=pt&nrm=iso&tlng=pt.CrossRefGoogle Scholar
Bartholomew, D.J., Knott, M., Moustaki, I.Latent variable models and factor analysis: a unified approach. Technometrics 2011.Google Scholar
Benazzi, F.Is overactivity the core feature of hypomania in bipolar II disorder?. Psychopathology 2007;40(1):54–60. [cited 2013 Aug 24] http://www.ncbi.nlm.nih.gov/pubmed/17065838.CrossRefGoogle ScholarPubMed
Benazzi, F., Akiskal, H.S.The dual factor structure of self-rated MDQ hypomania: energized-activity versus irritable-thought racing. J Affect Disord 2003;73(1–2):59–64http://www.ncbi.nlm.nih.gov/pubmed/12507738.CrossRefGoogle ScholarPubMed
Bentler, P.M., Mooijaart, A.Choice of structural model via parsimony: a rationale based on precision. Psychol Bull 1989;106(2):315–317. [cited 2013 Oct 12] http://doi.apa.org/getdoi.cfm?doi=10.1037/00332.315-2909106.CrossRefGoogle ScholarPubMed
Blashfield, R.K., Aldenderfer, M.S.The methods and problems of cluster analysis. Handbook of multivariate experimental psychology 2nd Ed. 1988;447–473.CrossRefGoogle Scholar
Cardoso, B.M., Kauer Sant’Anna, M., Dias, V.V., Andreazza, A.C., Ceresér, K.M., Kapczinski, F.The impact of co-morbid alcohol use disorder in bipolar patients. Alcohol 2008;42(6):451–457. [cited 2014 Jan 22] http://www.ncbi.nlm.nih.gov/pubmed/18760714.CrossRefGoogle ScholarPubMed
Carragher, N., Weinstock, L.M., Strong, D.Psychometric evaluation of the DSM-IV criterion B mania symptoms in an Australian national sample. Psychol Med 2012;1–11.Google Scholar
Cassidy, F.Anxiety as a symptom of mixed mania: implications for DSM-5. Bipolar Disord 2010;12(4):437–439. [cited 2013 Aug 24] http://www.ncbi.nlm.nih.gov/pubmed/20636641.CrossRefGoogle ScholarPubMed
Cassidy, F., Murry, E., Forest, K., Carroll, B.J.Signs and symptoms of mania in pure and mixed episodes. J Affect Disord 1998;50:187–201.CrossRefGoogle ScholarPubMed
Cassidy, F., Forest, K., Murry, E., Carroll, B.J.A factor analysis of the signs and symptoms of mania. Arch Gen Psychiatr 1998;55(1):27–32, http://www.ncbi.nlm.nih.gov/pubmed/9435757.CrossRefGoogle ScholarPubMed
Cheng, E.W.L.SEM being more effective than multiple regression in parsimonious model testing for management development research. J Manag Dev 2001;20(7):650–667. [cited 2013 Oct 12] http://www.emeraldinsight.com/10.1108/40262171011040056.CrossRefGoogle Scholar
Cheniaux, E., Filgueiras, A., Silva, R. de A da., Silveira, L.A.S., Nunes, A.L.S., Landeira-Fernandez, J.et al.Increased energy/activity, not mood changes, is the core feature of mania. J Affect Disord 2014;152–154:256–261. [cited 2014 Jan 27] http://www.ncbi.nlm.nih.gov/pubmed/24140225.CrossRefGoogle Scholar
Cole, D., a, , Cai, L., Martin, N.C., Findling, R.L., Youngstrom, E.et al.Structure and measurement of depression in youths: applying item response theory to clinical data. Psychol Assess 2011;23(4):819–833. [cited 2013 Aug 24] http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=727&tool=pmcentrez&rendertype=Abstract3743.CrossRefGoogle ScholarPubMed
Colom, F., Vieta, E.Melhorando o desfecho do transtorno bipolar usando estratégias não farmacológicas: o papel da psicoeducação. Rev Bras Psiquiatr 2004;26:47–50. [cited 2014 Jan 27] http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462004000700011&lng=pt&nrm=iso&tlng=pt.CrossRefGoogle Scholar
Egloff, B., Schmukle, S.C.Predictive validity of an implicit association test for assessing anxiety. J Pers Soc Psychol 2002;83(6):1441–1455. [cited 2013 Aug 8] http://doi.apa.org/getdoi.cfm?doi=10.1037/0022-3514.83.6.1441.CrossRefGoogle ScholarPubMed
Embretson, S.E., Reise, S.P.Item response theory (multivariate applications series). 1st Ed.New York: Psychology Press; 2000.Google Scholar
Endicott, J., Spitzer, R.L.Schedule for affective disorders and schizophrenia (SADS). Acta Psychiatr Belg 1978;87:361–516.Google Scholar
Everitt, B.S.Unresolved problems in cluster analysis. Biometrics 1979;35:169–181.CrossRefGoogle Scholar
Feske, U.Anxiety as a correlate of response to the acute treatment of bipolar I disorder. Am J Psychiatry 2000;157(6):956–962. [cited 2013 Oct 12] http://ajp.psychiatryonline.org/article.aspx?articleID=174166.CrossRefGoogle ScholarPubMed
Filgueiras, A., Fioravanti-Bastos, A.C.M., Charchat-Fichman, H., Cheniaux, E., Landeira-Fernandez, J.Avaliação da ansiedade por meio do teste de associação implícita. In: Landeira-Fernandez, J., Fukusima, S., editors. Métodos em Neurociência. Barueri: Manole; 2012. p. 56–65.Google Scholar
Furlanetto, L., Bueno, J.Depression in medical inpatients: validity of the SADS in a Brazilian sample. J Bras Psiquiatr 1999;48:435–440.Google Scholar
Goldberg, J.F., Garno, J.L., Portera, L., Leon, A.C., Kocsis, J.H., Whiteside, J.E.Correlates of suicidal ideation in dysphoric mania. J Affect Disord 1999;56(1):75–81. [cited 2014 Jan 28] http://linkinghub.elsevier.com/retrieve/pii/S0165032799000257.CrossRefGoogle ScholarPubMed
González-Pinto, A., Ballesteros, J., Aldama, A., Pérez De Heredia, J.L., Gutierrez, M., Mosquera, F.Principal components of mania. J Affect Disord 2003;76:95–102.CrossRefGoogle ScholarPubMed
Hair, J.F., Black, W.C., Babin, B.J., Anderson, R.E.Multivariate data analysis. 7th Ed.New York: Education PHH, Analysis; 2010.Google Scholar
Harvey, A.G., Schmidt, D.A., Scarnà, A., Semler, C.N., Goodwin, G.M.Sleep-related functioning in euthymic patients with bipolar disorder, patients with insomnia, and subjects without sleep problems. Am J Psychiatry 2005;162(1):50–57. [cited 2013 Oct 12] http://www.ncbi.nlm.nih.gov/pubmed/15625201.CrossRefGoogle ScholarPubMed
Henry, C., Swendsen, J., Van den Bulke, D., Sorbara, F., Demotes-Mainard, J., Leboyer, M.Emotional hyper-reactivity as a fundamental mood characteristic of manic and mixed states. Eur Psychiatry 2003;18(3):124–128, http://www.ncbi.nlm.nih.gov/pubmed/12763298.CrossRefGoogle ScholarPubMed
Henry, C., M’Baïlara, K., Desage, A., Gard, S., Misdrahi, D., Vieta, E.Towards a reconceptualization of mixed states, based on an emotional-reactivity dimensional model. J Affect Disord 2007;101(1–3):35–41. [cited 2013 Aug 24] http://www.ncbi.nlm.nih.gov/pubmed/17240456.CrossRefGoogle ScholarPubMed
Hwang, S.H., Rhee, M.K., Kang, R.H., Lee, H.Y., Ham, B.J., Lee, Y.S.et al.Development and validation of a screening scale for depression in Korea: the Lee and Rhee Depression Scale. Psychiatry Investig 2012;9(1):36–44, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=739&tool=pmcentrez&rendertype=Abstract3285.CrossRefGoogle Scholar
Jang, S.-H., Park, Y.-N., Jae, Y.-M., Jun, T.-Y., Lee, M.-S., Kim, J.-M.et al.The symptom frequency characteristics of the hamilton depression rating scale and possible symptom clusters of depressive disorders in Korea: The CRESCEND StYdy. Psychiatry Investig 2011;8(4):312–319, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3246138&tool=pmcentrez&rendertype=Abstract.CrossRefGoogle Scholar
Johnson, M.H., Magaro, P.A., Stern, S.L.Use of the SADS-C as a diagnostic and symptom severity measure. J Consult Clin Psychol 1986;54(4):546–551. [cited 2013 Aug 31] http://doi.apa.org/getdoi.cfm?doi=10.1037/0022-006X.54.4.546.CrossRefGoogle ScholarPubMed
Jöreskog, K.G., Moustaki, I.Factor analysis of ordinal variables: a comparison of three approaches. Multivar Behav Res 2001;36:347–387.CrossRefGoogle ScholarPubMed
Jöreskog, K.G., Sörbom, D.Interactive LISREL 9. 10. Skokie: Scientific Software Internationa; 2013.Google Scholar
Koukopoulos, A., Sani, G., Ghaemi, S.N.Mixed features of depression: why DSM-5 is wrong (and so was DSM-IV). Br J Psychiatry 2013;203:3–5.CrossRefGoogle Scholar
Krueger, R.F., Markon, K.E.Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annu Rev Clin Psychol 2006;2:111–133. [cited 2013 Sep 27]http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2242354&tool=pmcentrez&rendertype=abstract.CrossRefGoogle ScholarPubMed
Loehlin, J.C.Latent variable model: an introduction to factor path and structural equation analysis. 4th Ed.Mahwah: Lawrence Erlbaum Associates; 2009.Google Scholar
Luo, H.Some aspects on confirmatory factor analysis of ordinal variables and generating non-normal data. [Doctoral thesis] Uppsala University; 2011. 9–32.Google Scholar
Malloy-Diniz, L.F., Neves, F.S., Abrantes, S.S.C., Fuentes, D., Corrêa, H.Suicide behavior and neuropsychological assessment of type I bipolar patients. J Affect Disord 2009;112(1–3):231–236. [cited 2014 Jan 22] http://www.ncbi.nlm.nih.gov/pubmed/18485487.CrossRefGoogle ScholarPubMed
Minassian, A., Henry, B.L., Geyer, M.A., Paulus, M.P., Young, J.W.et al.The quantitative assessment of motor activity in mania and schizophrenia. J Affect Disord 2010 120(1–3):200–206. Elsevier B.V., cited 2013 Aug 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2795051&tool=pmcentrez&rendertype=Abstract.CrossRefGoogle Scholar
Newby, P.K., Tucker, K.L.Empirically derived eating patterns using factor or cluster analysis: a review. Nutr Rev 2004;62(5):177–203. [cited 2014 Jan 27] http://doi.wiley.com/10.1111/j.1753-4887.2004.tb00040.x.CrossRefGoogle ScholarPubMed
Papolos, D., Hennen, J., Cockerham, M.S., Lachman, H.A strategy for identifying phenotypic subtypes: concordance of symptom dimensions between sibling pairs who met screening criteria for a genetic linkage study of childhood-onset bipolar disorder using the Child Bipolar Questionnaire. J Affect Disord 2007;99(1–3):27–36. [cited 2014 Jan 28] http://www.ncbi.nlm.nih.gov/pubmed/17049378.CrossRefGoogle ScholarPubMed
Rogers, R., Jackson, R.L., Salekin, K.L., Neumann, C.S., Assessing Axis, I.symptomatology on the SADS-C in two correctional samples: the validation of subscales and a screen for malingered presentations. J Pers Assess 2003;81(3):281–290. [Internet] http://www.ncbi.nlm.nih.gov/pubmed/14638453.CrossRefGoogle Scholar
Saito, M., Iwata, N., Kawakami, N., Matsuyama, Y.Evaluation of the DSM-IV and ICD-10 criteria for depressive disorders in a community population in Japan using item response theory; 2010;211–222.Google Scholar
Sato, T., Bottlender, R., Kleindienst, N.Am J Psychiatry 2002;159(6):968–974. http://www.ncbi.nlm.nih.gov/pubmed/12042185.CrossRefGoogle Scholar
Schmukle, S.C., Egloff, B.Does the implicit association test for assessing anxiety measure trait and state variance? 2004;494:483–494 [October 2003].Google Scholar
Serrano, E., Ezpeleta, L., Alda, J.A., Matalí, J.L., San, L.Psychometric properties of the Young Mania Rating Scale for the identification of mania symptoms in Spanish children and adolescents with attention deficit/hyperactivity disorder. Psychopathology 2011;44:125–132.CrossRefGoogle Scholar
Simon, N.M., Otto, M.W., Wisniewski, S.R., Fossey, M., Sagduyu, K., Frank, E.et al.Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry 2004;161(12):2222–2229. [cited 2013 Oct 12] http://www.ncbi.nlm.nih.gov/pubmed/15569893.CrossRefGoogle Scholar
Spitzer, R.L., Endicott, J.Schedule for affective disorders and schizophrenia: change version. Biometrics. New York: New York State Psychiatric Institute; 1978.Google Scholar
Swann, A., Janicak, P., Calabrese, J., Bowden, C., Dilsaver, S., Morris, D.et al.Structure of mania: depressive, irritable, and psychotic clusters with different retrospectively-assessed course patterns of illness in randomized clinical trial participants. J Affect Disord 2001;67(1–3):123–132. [Internet] http://www.ncbi.nlm.nih.gov/pubmed/11869759.CrossRefGoogle ScholarPubMed
Swann, A.C., Daniel, D.G., Kochan, L.D., Wozniak, P.J., Calabrese, J.R.Psychosis in Mania: Specificity of Its Role in Severity and Treatment Response. J Clin Psychiatry 2004;65:825–829. [Internet] http://article.psychiatrist.com/dao_1-login.asp?ID=10000939&RSID=22834998915633.CrossRefGoogle ScholarPubMed
Swann, A.C., Steinberg, J.L., Lijffijt, M., Moeller, F.G.Impulsivity: differential relationship to depression and mania in bipolar disorder. J Affect Disord 2008;106(3):241–248. [Internet, cited 2013 Aug 31] http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2683682&tool=pmcentrez&rendertype=Abstract.CrossRefGoogle ScholarPubMed
Swann, A.C., Steinberg, J.L., Lijffijt, M., Moeller, G.F.Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features. World Psychiatry 2009;8:166–172.CrossRefGoogle ScholarPubMed
Swann, A.C., Lijffijt, M., Lane, S.D., Steinberg, J.L., Moeller, F.G.Antisocial personality disorder and borderline symptoms are differentially related to impulsivity and course of illness in bipolar disorder. J Affect Disord 2013;148(2–3):384–390. [Internet, cited 2013 Aug 31] http://www.ncbi.nlm.nih.gov/pubmed/22835849.CrossRefGoogle ScholarPubMed
Thompson, P.A., Meltzer, H.Y.Positive, negative, and disorganisation factors from the Schedule for Affective Disorders and Schizophrenia and the Present State Examination. A three-factor solution. Br J Psychiatry 1993;163:344–351.CrossRefGoogle ScholarPubMed
Van Vliet, I.M., De Beurs, E.The MINI-International Neuropsychiatric Interview. A brief structured diagnostic psychiatric interview for DSM-IV en ICD-10 psychiatric disorders. Tijdschr Psychiatr 2007;49:393–397.Google ScholarPubMed
World Health, , Organization, International statistical classification of diseases and related health problems [Internet]. [cited 2013 Aug 31]2013, http://apps.who.int/classifications/icd10/browse/2010/en.Google Scholar
Submit a response

Comments

No Comments have been published for this article.