Cassano G B, Mula M, Rucci P, Miniati M, Frank E, Kupfer D J, Oppo A, Calugi S, Maggi L, Gibbons R, Fagiolini A
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Italy.
J Affect Disord. 2009 Jan;112(1-3):59-70. doi: 10.1016/j.jad.2008.04.019. Epub 2008 Jun 9.
The observation that bipolar disorders frequently go unrecognized has prompted the development of screening instruments designed to improve the identification of bipolarity in clinical and non-clinical samples. Starting from a lifetime approach, researchers of the Spectrum Project developed the Mood Spectrum Self-Report (MOODS-SR) that assesses threshold-level manifestations of unipolar and bipolar mood psychopathology, but also atypical symptoms, behavioral traits and temperamental features. The aim of the present study is to examine the structure of mania/hypomania using 68 items of the MOODS-SR that explore cognitive, mood and energy/activity features associated with mania/hypomania.
A data pool of 617 patients with bipolar disorders, recruited at Pittsburgh and Pisa, Italy was used for this purpose. Classical exploratory factor analysis, based on a tetrachoric matrix, was carried out on the 68 items, followed by an Item Response Theory (IRT)-based factor analytic approach.
Nine factors were initially identified, that include Psychomotor Activation, Creativity, Mixed Instability, Sociability/Extraversion, Spirituality/Mysticism/Psychoticism, Mixed Irritability, Inflated Self-esteem, Euphoria, Wastefulness/Recklessness, and account overall for 56.4% of the variance of items. In a subsequent IRT-based bi-factor analysis, only five of them (Psychomotor Activation, Mixed Instability, Spirituality/Mysticism/Psychoticism, Mixed Irritability, Euphoria) were retained.
Our data confirm the central role of Psychomotor Activation in mania/hypomania and support the definitions of pure manic (Psychomotor Activation and Euphoria) and mixed manic (Mixed Instability and Mixed Irritability) components, bearing the opportunity to identify patients with specific profiles for a better clinical and neurobiological definition.
双相情感障碍常常未被识别，这一现象促使人们开发筛查工具，以提高在临床和非临床样本中对双相情感障碍的识别能力。从终生患病的角度出发，“谱系项目”的研究人员开发了情绪谱系自评量表（MOODS-SR），该量表不仅评估单相和双相情绪精神病理学的阈下表现，还评估非典型症状、行为特征和气质特征。本研究的目的是使用MOODS-SR中的68个项目来检验躁狂/轻躁狂的结构，这些项目探讨了与躁狂/轻躁狂相关的认知、情绪和能量/活动特征。
为此使用了在意大利匹兹堡和比萨招募的617例双相情感障碍患者的数据集。对这68个项目进行基于四分相关矩阵的经典探索性因素分析，随后采用基于项目反应理论（IRT）的因素分析方法。
最初识别出九个因素，包括精神运动性激越、创造力、混合性不稳定、社交性/外向性、灵性/神秘主义/精神病性、混合性易激惹、自尊膨胀、欣快感、浪费/鲁莽，这些因素总共解释了项目方差的56.4%。在随后基于IRT的双因素分析中，仅保留了其中五个因素（精神运动性激越、混合性不稳定、灵性/神秘主义/精神病性、混合性易激惹、欣快感）。
我们的数据证实了精神运动性激越在躁狂/轻躁狂中的核心作用，并支持了纯躁狂（精神运动性激越和欣快感）和混合性躁狂（混合性不稳定和混合性易激惹）成分的定义，这为识别具有特定特征的患者提供了机会，以便进行更好的临床和神经生物学定义。
