This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Scale Characteristics and Implications for the Study of Mania

Mark S. Bauer, MD; Paul Crits-Christoph, PhD; William A. Ball, MD, PhD; Edward Dewees; Thomas McAllister, MD; Peter Alahi; John Cacciola, PhD; Peter C. Whybrow, MD

Arch Gen Psychiatry. 1991;48(9):807-812.

Abstract
• We report the reliability and validity of the Internal State Scale, a self-report instrument for the simultaneous assessment of severity of manic and depressive symptoms. The Internal State Scale consists of four empirically derived subscales: Activation, Well-Being, Perceived Conflict, and the Depression Index. All subscales had good internal consistency reliability. Activation subscale scores were significantly higher in manic patients than in depressed patients or control subjects, while Well-Being subscale scores were significantly lower and the Depression Index subscale scores were significantly higher in depressed patients than in the other two groups. Activation subscale scores were correlated specifically with clinician ratings of mania. Depression Index subscale scores were correlated specifically with clinician ratings of depression. Further evidence for the validity of the subscales of the Internal State Scale in reflecting manic or depressive symptoms came from discriminant function analysis in which these subscales assigned 88% of subjects to the correct diagnostic groups. In affectively ill patients who were studied in two or more mood states, Activation, Depression Index, and Well-Being subscale scores changed significantly in the predicted directions, while the same discriminant algorithm assigned 79% of mood states to the correct diagnostic category. Bimodal distribution of scores of manic patients on the Well-Being and Depression Index subscales substantiated earlier findings that euphoric mood is not an essential feature of mania. Based on findings from this and previous studies, the hypothesis is proposed that variables related to activation level, and not to mood state, constitute the core characteristics of the manic syndrome.

Author Affiliations
From the Departments of Psychiatry (Drs Bauer, Crits-Christoph, Ball, McAllister, Cacciola, and Whybrow and Messrs Dewees and Alahi) and Pharmacology (Dr Bauer), University of Pennsylvania, Philadelphia. Dr Bauer is now with the Outpatient Psychiatry Section, Department of Veterans Affairs Medical Center, Providence, RI.

Footnotes
Accepted for publication February 27, 1991.

Reprint requests to Outpatient Psychiatry Section, Department of Veterans Affairs Medical Center, 830 Chalkstone Ave, Providence, RI 02908-4799 (Dr Bauer).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Clinical and Demographic Factors Associated With Homelessness and Incarceration Among VA Patients With Bipolar Disorder
Copeland et al.
AJPH 2009;99:871-877.
ABSTRACT | FULL TEXT  

Long-term Effectiveness and Cost of a Systematic Care Program for Bipolar Disorder.
Simon et al.
Arch Gen Psychiatry 2006;63:500-508.
ABSTRACT | FULL TEXT  

Cost-effectiveness of relapse-prevention cognitive therapy for bipolar disorder: 30-month study
LAM et al.
Br. J. Psychiatry 2005;186:500-506.
ABSTRACT | FULL TEXT  

Demystifying the Disease State: Understanding Diagnosis and Treatment Across the Bipolar Spectrum
Lewis
J Am Psychiatr Nurses Assoc 2004;10:S6-S15.
ABSTRACT  

Effect of Lamotrigine on Mood and Cognition in Patients Receiving Chronic Exogenous Corticosteroids
Brown et al.
Psychosomatics 2003;44:204-208.
ABSTRACT | FULL TEXT  

A Randomized Controlled Study of Cognitive Therapy for Relapse Prevention for Bipolar Affective Disorder: Outcome of the First Year
Lam et al.
Arch Gen Psychiatry 2003;60:145-152.
ABSTRACT | FULL TEXT  

Effects of acute tryptophan depletion on mood and suicidal ideation in bipolar patients symptomatically stable on lithium
HUGHES et al.
Br. J. Psychiatry 2000;177:447-451.
ABSTRACT | FULL TEXT  

Factor Analysis of Mania
Serretti et al.
Arch Gen Psychiatry 1999;56:671-672.
FULL TEXT  

A Factor Analysis of the Signs and Symptoms of Mania
Cassidy et al.
Arch Gen Psychiatry 1998;55:27-32.
ABSTRACT | FULL TEXT  

What Is the 'Core' Symptom of Mania?
Gardner and Wenegrat
Arch Gen Psychiatry 1993;50:70-71.
ABSTRACT