Search

Introduction: A significant number of patients experience recurrent episodes of mania without depressive episodes. Evidence from the available literature suggests that these patients differ from typical "bipolar" or "manic-depressive" patients, but results have been inconsistent. The current study aims to add to this literature by comparing the demographic, clinical and risk factor profiles of patients with recurrent mania with and without depression., Methods: 66 patients with a diagnosis of bipolar I disorder were divided into "unipolar mania" (recurrent mania alone, MA) and "bipolar" (both mania and depression, MD) sub-groups. Comorbid diagnoses were assessed using the Mini International Neuropsychiatric Interview (MINI), and genetic and environmental risk factors were explored using the Diagnostic Interview for Genetic Studies (DIGS), Childhood Trauma Questionnaire (CTQ), and an additional questionnaire designed for the purpose of the study. Differences between the MA and MD groups in terms of demographic variables, clinical profile, comorbidities and antecedent risk factors were explored., Results: Patients with both mania and depression had higher frequencies of lifetime suicide attempts, antidepressant treatment, and catatonic symptoms. There was some evidence of an association between overcrowding in childhood and the presence of depressive episodes. No other differences in demographic, clinical or risk factor variables could be found between the two groups., Discussion: Our results are consistent with the view that unipolar mania is not a distinctive disorder, or even a distinctive subtype of bipolar disorder. However, this conclusion is provisional as it is based only on clinical and demographic data., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Catatonia is a frequent psychomotor syndrome, which has received increasing recognition over the last decade. The assessment of the catatonic syndrome requires systematic rating scales that cover the complex spectrum of catatonic motor signs and behaviors. The Catatonia Rating Scale (CRS) is such an instrument, which has been validated and which has undergone extensive reliability testing. In the present study, to further validate the CRS, the items composing this scale were submitted to principal components factor extraction followed by a varimax rotation. An analysis of variance (ANOVA) was performed to assess group differences on the extracted factors in patients with schizophrenia, pure mania, mixed mania, and major depression (N=165). Four factors were extracted, which accounted for 71.5% of the variance. The factors corresponded to the clinical syndromes of (1) catatonic excitement, (2) abnormal involuntary movements/mannerisms, (3) disturbance of volition/catalepsy, and (4) catatonic inhibition. The ANOVA revealed that each of the groups showed a distinctive catatonic symptom pattern and that the overlap between diagnostic groups was minimal. We conclude that this four-factor symptom structure of catatonia challenges the current conceptualization, which proposes only two symptom subtypes.

The study objective is to present reliability data on the Catatonia Rating Scale (CRS). The CRS is a 21-item clinician-administered rating scale. Items are individually defined and are scored from 0 (absent) to 4 (severe). A definition for each degree of severity is provided for each item. The diagnostic threshold for catatonia is 4 symptoms rated at least 2 (moderate). The CRS requires, at most, 45 minutes to administer. Reliability data were evaluated in a sample of 120 inpatients, 71 of whom were catatonic. Ratings were performed by 4 pairs of raters. Interrater reliability was high (Pearson correlation coefficient = .91 to .99, intraclass correlation coefficient = .94 to .99). Internal consistency was very good (Cronbach's alpha = .8890). Analysis of individual items showed that all were frequently endorsed and occurred across a wide range of severity. The CRS is a reliable rating scale for the diagnosis of catatonia. Advantages of the scale, areas of use, and clinical implications are discussed.

The study investigates the prevalence, clinical characteristics, and implications of catatonic symptoms in mania. Sixty-one inpatients with DSM-III-R bipolar disorder (BD), manic or mixed episode, established by the Structured Clinical Interview for DSM-III-R (SCID) were assessed for the presence of catatonic by a 21-item rating scale. Nineteen patients fulfilled criteria for catatonic mania, exhibiting between five and 16 catatonic symptoms. Catatonic manics had more mixed episodes, more severe manic symptoms, more general psychopathology, a higher prevalence of comorbidity, a longer hospitalization, and lower Global Assessment of Functioning (GAF) scores than the noncatatonics. The results indicate that catatonic symptoms are a marker of a more severe course and outcome in mania.

Kahlbaum described catatonia as a disorder in which mood syndromes were the primary features and characteristic symptoms were the motor ones. However, after Kahlbaum this concept has not been taken into account and catatonia has been identified with motor features alone. In the present study, we assessed the clinical validity of Kahlbaum's concept of catatonia, its nosological position in relation to DSM-III-R, DSM-IV, and Leonhard's diagnostic criteria, and its relationships with schizophrenia and mood disorder. Of 567 patients consecutively admitted due to a functional psychotic disorder, 45 met criteria for catatonia according to Kahlbaum's concept (the Kahlbaum syndrome [KS]). Patients with the KS were differentiated from those with schizophrenia and mood disorders across a number of demographic and clinical variables, the differences being greater with the former than with the latter group. KS does not appear to fit any particular nosologic category, although this issue largely depends on whether schizophrenia and mood disorder are broadly or restrictively defined. When definitions of both disorders are most restrictive, as in the case of the Leonhard system, KS seems better accommodated as a "third psychosis". Overall, the data raise the possibility that KS is either a variant of mood disorder, or a distinct clinical entity.