To identify the factor structure of manic symptoms in adolescents as assessed by the Scale for Manic States (SMS).
Method
Pattern of symptoms was assessed in a group of 100 adolescents with a diagnosis of manic episode as defined by the International Classification of Diseases, 10th revision Diagnostic Criteria for Research. A principal component analysis of the broad range of psychiatric symptoms covered by the SMS was conducted.
Results
Seven eigenvalues were greater than unity, and parallel analysis revealed 5 factors, whereas scree plot was inconclusive. Five-factor solution as obtained by parallel analysis was chosen, which described our data appropriately and were clinically relevant. The 5 factors were: aggressive overactivity, dysphoria, psychosis, hedonia, and thought retardation. These captured 58.14% of the total variance.
Conclusions
These 5 factors explain the clinical dimensions in adolescent mania similar to those of the adult population. Nevertheless, certain features, such as presence of psychosis along with euphoric mood and thought retardation, distinguish adolescent from adult mania.
YoungRC, BiggsJT, ZieglerVE, . A rating scale for mania: reliability, sensitivity and validity. Br J Psychiatry. 1978;133:429–435.
6.
PostRM, RubinowDR, UhdeTW, . Dysphoric mania. Clinical and biological correlates. Arch Gen Psychiatry. 1989;46:353–358.
7.
RossiA, DaneluzzoE, ArduiniL, . A factor analysis of signs and symptoms of the manic episode with Bech-Rafaelsen Mania and Melancholia Scales. J Affect Disord. 2001;64:267–270.
8.
Gonzalez-PintoA, BallesterosJ, AldamaA, . Principal components of mania. J Affect Disord. 2003;76:95–102.
9.
CassidyF, ForestK, MurryE, . A factor analysis of the signs and symptoms of mania. Arch Gen Psychiatry. 1998;55:27–32.
10.
GuptaSC, SinhaVK, PraharajSK, . Factor analysis of manic symptoms. Aust N Z J Psychiatry. 2009;43:1141–1146.
11.
CarlsonGA, KashaniJH.Manic symptoms in a non-referred adolescent population. J Affect Disord. 1988;15:219–226.
12.
LewinsohnPM, KleinDN, SeeleyJR.Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J Am Acad Child Adolesc Psychiatry. 1995;34:454–463.
13.
GellerB, LubyJ.Child and adolescent bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1997;36:1168–1176.
14.
BallengerJC, ReusVI, PostRM.The “atypical” clinical picture of adolescent mania. Am J Psychiatry. 1982;139:602–606.
15.
WellerEB, WellerRA.Assessing depression in prepubertal children. HillsideJ Clin Psychiatry. 1986;8:193–201.
16.
CarlsonGA.Bipolar disorder in childhood and adolescence. In: CantwellWP, CarlsonGA, eds. Affective disorders in childhood and adolescence: an update.New York, NY: SP Medical and Scientific Books; 1983.
17.
HsuLK, StarzynskiJM.Mania in adolescence. J Clin Psychiatry. 1986;47:596–599.
GellerB, SunK, ZimermanB, . Complex and rapid-cycling in bipolar children and adolescents: a preliminary study. J Affect Disord. 1995;34:259–268.
20.
KothariS.Phenomenology of childhood and adolescent mania: a clinical study [MD in Psychiatry thesis].Ranchi, India: Ranchi University; 1998.
21.
YoungstromEA, DanielsonCK, FindlingRL, . Factor structure of the Young Mania Rating Scale for use with youths ages 5 to 17 years. J Clin Child Adolesc Psychol. 2002;31:567–572.
22.
FrazierTW, DemeterCA, YoungstromEA, . Evaluation and comparison of psychometric instruments for pediatric bipolar spectrum disorders in four age groups. J Child Adolesc Psychopharmacol. 2007;17:853–866.
23.
PavuluriMN, HenryDB, DevineniB, . Child mania rating scale: development, reliability, and validity. J Am Acad Child Adolesc Psychiatry. 2006;45:550–560.
24.
World Health Organization. The ICD-10 classification of mental and behavioral disorders: diagnostic criteria for research.Geneva, Switzerland: World Health Organization; 1993.
25.
McElroySL, KeckPEJr, PopeHGJr, . Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania. Am J Psychiatry. 1992;149:1633–1644.
26.
AndreasonNC.Comprehensive Assessment of symptoms and History (CASH).Iowa City, IA: The University of Iowa; 1985.
27.
KaiserHF.A second generation little jiffy. Psychometrika. 1970;35:401–415.
28.
CattellRB.The scree test for number of factors. Multivariate Behavioral Research. 1966;1:245–276.
29.
HornJL.A rationale and test for the number of factors in factor analysis. Psychometrika. 1965;30:179–185.
30.
KeelingKB.A regression equation for determining the dimensionality of data. Multivariate Behavioral Research. 2000;35:457–468.
31.
StevensJP.Applied multivariate statistics for the social sciences. Hillsdale, NJ: Lawrence Erlbaum Associates; 1992.
32.
ZwickWR, VelicerWF.Comparison of five rules for determining the number of components to retain. Psychol Bull. 1986;99:432–442.
33.
GuoY, NilssonME, HeiligensteinJ, . An exploratory factor analysis of the Children's Depression Rating Scale-Revised. J Child Adolesc Psychopharmacol. 2006;16:482–491.
34.
DilsaverSC, ChenYR, ShoaibAM, . Phenomenology of mania: evidence for distinct depressed, dysphoric, and euphoric presentations. Am J Psychiatry. 1999;156:426–430.
35.
TaylorMA, AbramsR.The phenomenology of mania. A new look at some old patients. Arch Gen Psychiatry. 1973;29:520–522.
36.
StreinerDL.Figuring out factors: the use and misuse of factor analysis. Can J Psychiatry. 1994:39:135–140.
