Picardi Angelo, Battisti Francesca, de Girolamo Giovanni, Morosini Pierluigi, Norcio Bruno, Bracco Renata, Biondi Massimo
Italian National Institute of Health, Center of Epidemiology, Surveillance and Health Promotion, Mental Health Unit, Viale Regina Elena, 299 - 00161 Rome, Italy.
J Affect Disord. 2008 May;108(1-2):183-9. doi: 10.1016/j.jad.2007.09.010. Epub 2007 Oct 29.
Despite increasing interest in dimensional psychopathology and the use of symptom clusters in clinical research, factor analytic studies of mania are rare. Most studies included not only manic patients, but also patients with a mixed episode or other severe mental disorders. We aimed at further elucidating the symptom structure of manic states.
As part of a national survey of acute psychiatric inpatient care, all patients admitted to a random sample of Italian public and private facilities during an index period underwent a standardized assessment, including the 24-item Brief Psychiatric Rating Scale (BPRS-24). Eighty-eight patients (90% of all manic patients admitted) with an ICD-10 diagnosis of Bipolar Affective Disorder, Current Episode Manic with complete data were included in this study. Principal axis factor analysis with Varimax rotation was performed on BPRS-24 items.
Four factors were extracted, explaining 51% of total variance. They were interpreted as Mania, Disorganization, Positive Symptoms, and Dysphoria. The distribution of the Disorganization factor was positively skewed, with most patients relatively free from disorganization symptoms and some patients showing varying degrees of severity.
The sample size was relatively small; also, patients were not administered a structured diagnostic interview. However, reasonably large samples are usually sufficient when communalities are high. Also, the manic episode is a clear-cut diagnostic entity easily identified by experienced clinicians, and the independent BPRS-24 ratings corroborated the diagnosis.
The identification of a Mania, Positive Symptoms, and Dysphoria factor is consistent with most previous studies. The identification of a Disorganization factor in a sample including only manic patients is a new finding that may have clinical implications, as its distribution suggests the possibility of distinguishing two patient groups, which may require different interventions to achieve optimal therapeutic response. The factorially derived BPRS-24 subscales may be useful for evaluation of treatment effects in clinical trials of antimanic agents.
尽管对维度精神病理学以及临床研究中症状群的应用兴趣日增，但针对躁狂症的因素分析研究却很罕见。大多数研究不仅纳入了躁狂症患者，还纳入了混合发作或其他严重精神障碍的患者。我们旨在进一步阐明躁狂状态的症状结构。
作为一项全国性急性精神科住院护理调查的一部分，在索引期内，从意大利公立和私立机构随机抽取的所有入院患者都接受了标准化评估，包括24项简明精神病评定量表（BPRS - 24）。本研究纳入了88例国际疾病分类第10版（ICD - 10）诊断为双相情感障碍、当前发作躁狂且数据完整的患者（占所有入院躁狂症患者的90%）。对BPRS - 24项目进行了主成分轴因子分析并采用方差最大化旋转。
提取出四个因子，解释了总方差的51%。它们被解释为躁狂、紊乱、阳性症状和烦躁不安。紊乱因子的分布呈正偏态，大多数患者相对没有紊乱症状，一些患者表现出不同程度的严重程度。
样本量相对较小；此外，未对患者进行结构化诊断访谈。然而，当共同度较高时，合理的大样本通常就足够了。而且，躁狂发作是一个明确的诊断实体，经验丰富的临床医生很容易识别，独立的BPRS - 24评分也证实了诊断。
躁狂、阳性症状和烦躁不安因子的识别与大多数先前研究一致。在仅包括躁狂症患者的样本中识别出紊乱因子是一项新发现，可能具有临床意义，因为其分布表明有可能区分两组患者，这两组患者可能需要不同的干预措施以实现最佳治疗反应。基于因子分析得出的BPRS - 24分量表可能有助于评估抗躁狂药物临床试验中的治疗效果。
