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Manic episodes, which are mandatory for the diagnosis of bipolar disorder, are traditionally viewed as "mood episodes."¹ It has been proposed that variables related to activation level, and not to mood state, constitute the core characteristics of the manic syndrome.²

As exact phenotype characterization is crucial for the identification of biological and genetic markers, the available diagnoses systems may be insufficient. In a recent article Cassidy et al³ describe the symptom structure of mania identifying dysphoria, psychomotor acceleration, psychosis, increased hedonic function, and irritable aggression as separate factors in a sample of 237 bipolar subjects. They point out the substantial lack of empirical studies supporting the psychopathological definition of manic states.^4-5 Therefore, a replication on a large sample is needed.

We collected data from 523 white subjects (females/males=341/182; mean (±SD) age=45.134 ± 13.99 years; mean (±SD) onset=29.92±23.80 years) consecutively admitted to the Mood Disorder Center of San Raffaele Hospital, Milan, . . . [Full Text of this Article]

Corresponding author: Alessandro Serretti, MD, Department of Neuropsychiatric Sciences, Ospedale San Raffaele, University of Milan School of Medicine, Via Luigi Prinetti 29, 20127 Milan, Italy (e-mail: serretti.alessandro@hsr.it).

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