Towards a reconceptualization of mixed states, based on an emotional-reactivity dimensional model.

Chantal Henry, Katia M'Baïlara, Alain Desage, Sébastien Gard, David Misdrahi, Eduard Vieta
Journal of Affective Disorders. 2007-08-01; 101(1-3): 35-41
DOI: 10.1016/j.jad.2006.10.027

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1. J Affect Disord. 2007 Aug;101(1-3):35-41. doi: 10.1016/j.jad.2006.10.027. Epub
2007 Jan 22.

Towards a reconceptualization of mixed states, based on an emotional-reactivity
dimensional model.

Henry C(1), M’Baïlara K, Desage A, Gard S, Misdrahi D, Vieta E.

Author information:
(1)Hôpital Charles Perrens, Bâtiment Lescure, 121 rue de la Béchade, 33076
Bordeaux Cedex, France.

BACKGROUND: DSM-IV criteria for mixed states may be too restrictive and may
actually exclude patients who do not meet the full criteria for a manic and
depressive state. Using this DSM-IV definition, many patients who are considered
depressed may have mixed features, which can explain why some bipolar depressive
states can worsen with antidepressants and can be improved by mood stabilizers
or atypical antipsychotics. A dimensional approach not exclusively focused on
the tonality of affect would help to define a broader entity of mixed states.
The aim of this study was to apply a dimensional model to bipolar episodes and
to assess the overlap between the groups defined using this model and using
categorical diagnosis.
METHOD: We assessed 139 DSM-IV acutely ill bipolar I patients with MAThyS
(Multidimensional Assessment of Thymic States by Henry et al. in press), a scale
that assesses five quantitative dimensions exploring excitatory and inhibition
processes, and that is not focused on tonality of mood but on emotional
reactivity. We studied the relationship between clusters defined by statistical
analyses and DSM-IV bipolar mood states.
RESULTS: This study showed the existence of three clusters. Cluster 1 was
characterized by an inhibition in all dimensions and corresponded to the
depressive cluster (more than 90% of patients met the criteria for DSM-IV Major
Depressive Episode (MDE)). Cluster 2 showed a general excitation and was mainly
DSM-IV manic or hypomanic patients (90%). Cluster 3 (Mixed) was more complex and
the diagnosis included MDE (56%) in most of the cases associated with manic or
hypomanic symptoms, mixed states (18%) defined by DSM-IV criteria, and manic or
hypomanic states (25%). Emotional reactivity was relevant to distinguish Cluster
1 (Depressive), exhibiting emotional hypo-reactivity, from Cluster 2 (Manic) and
3 (Mixed), characterized by emotional hyper-reactivity. Sadness was reported
equally in all three clusters.
CONCLUSION: A dimensional approach using the concept of emotional reactivity
seems appropriate to define a broad mixed state entity in patients who would be
diagnosed with MDE according to DSM-IV. Further studies are needed to test the
relevance of this model in therapeutic strategies.

DOI: 10.1016/j.jad.2006.10.027
PMID: 17240456 [Indexed for MEDLINE]

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