Academic journal article Indian Journal of Psychiatry

A Factor Analytical Study Report on Mania from Nepal

Academic journal article Indian Journal of Psychiatry

A Factor Analytical Study Report on Mania from Nepal

Article excerpt

Byline: Sanjeev. Shah, Tapas. Aich, Sandip. Subedi

Background and Objectives: Phenomenological studies on mood disorder are rare in Nepal which prompted us to undertake the current factor analytical study of mania. Materials and Methods: It was a cross-sectional descriptive study for which we did purposive sampling technique according to certain inclusion and exclusion criteria. The study sample consists of fifty patients, who fulfilled the International Classification of Diseases, Tenth Edition (ICD-10) diagnostic criteria for Manic Episode and/or Bipolar Affective Disorder-current episode mania. Tools used were ICD-10 Diagnostic Criteria for Research, Young's Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). Principal component factor analysis was applied to the 35 symptoms taken from YMRS and BPRS. Results: Factor analysis revealed the presence of four main factors, which explained 51.082% of the total variance. These are “pure mania” which isolated 11 manic symptoms, “dysphoric mania” which isolated five depressive symptoms, “hostile mania” which isolated six symptoms, and the fourth factor, we called it “delirious mania,” isolated four symptoms. Conclusion: The identified factors and subtypes are a useful conceptualization of atypical features among patients with acute mania. Further validation studies are required to determine whether the identified subtypes are of clinical and theoretical importance.

Introduction

In 1899, Emil Kraepelin categorized mental disorder into two groups: “dementia praecox” and “manic–depressive psychosis.”[sup][1] He was one of the first authors to describe the clinical subtypes of affective disorder (bipolar disorder, manic, depressive, and mixed types) and directed attention toward the depressive and labile features of mania.[sup][2] More than 70% of all manic cases showed elated/euphoric mood, decreased need for sleep, or racing thoughts. Roughly 69% of cases also showed poor judgment, whereas only half of bipolar cases demonstrated flight of ideas, and slightly more than one-third showed hypersexuality or psychotic features.[sup][3]

Kraepelin later described six types of mixed states based on various combinations of mood, will (volition), and thought processes: manic stupor (elevated mood but decreased will and thought), depressive mania (depressed mood but elevated will and thought), excited depression (depressed mood and will but elevated thought), depression with flight of ideas (depressed mood and thought but elevated will), mania with poverty of thought (elevated mood and will but decreased thought), and inhibited mania (elevated mood and thought but decreased will).[sup][4] Phenomenological studies are rare in Nepal which prompted us to undertake the current factor analytical study of mania.

Materials and Methods

The study was conducted in the Department of Psychiatry, Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Nepal. It was a cross-sectional descriptive study for which we did purposive sampling technique according to certain inclusion and exclusion criteria. The samples were recruited from patients admitted in our inpatient psychiatry department in UCMS-TH. A total of fifty patients were recruited for the study, within a stipulated time period. Inclusion criteria were patients fulfilling and diagnosed as the first-episode mania and/or bipolar affective disorder-current episode mania or mixed episode according to the International Classification of Diseases, Tenth Edition (ICD-10) Diagnostic Criteria for Research (ICD-10),[sup][5] either sex in the age range of 15–45 years, drug naive, and having given informed consent for the study. Exclusion criteria were substance-induced mood disorder-mania, organic mood disorder, diagnosis of mania in a mentally disabled person, and patients who were not cooperative and who did not gave consent for the study. …

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