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75-583: The GBI was originally made as a self-report instrument for college students and adults to use to describe their own history of mood symptoms. The original item set included clinical characteristics and associated features in addition to the diagnostic symptoms of manic and depressive states in the current versions of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association . The first set of 69 items

150-484: A large sample of teachers complete the GBI to describe the mood and behavior of youths age 5 to 18 years old. The results indicated that there were many items that teachers did not have an opportunity to observe the behavior (such as the items asking about sleep), and others that teachers often chose to skip. Even after shortening the item list to those that teachers could report about, the validity results were modest even though

225-417: A level far beyond that which they would be capable of during euthymia . A very simple indicator of a manic state would be if a heretofore clinically depressed patient suddenly becomes inordinately energetic, enthusiastic, cheerful, aggressive, or "over-happy". Other, often less obvious, elements of mania include delusions (generally of either grandeur or persecution , according to whether the predominant mood

300-502: A liability. English actor Stephen Fry , who has bipolar disorder , recounts manic behaviour during his adolescence: "When I was about 17 ... going around London on two stolen credit cards, it was a sort of fantastic reinvention of myself, an attempt to. I bought ridiculous suits with stiff collars and silk ties from the 1920s, and would go to the Savoy and Ritz and drink cocktails." While he has experienced suicidal thoughts , he says

375-436: A manic episode as one where mood is higher than the person's situation warrants and may vary from relaxed high spirits to barely controllable exuberance, is accompanied by hyperactivity, a compulsion to speak, a reduced sleep requirement, difficulty sustaining attention, and/or often increased distractibility. Frequently, confidence and self-esteem are excessively enlarged, and grand, extravagant ideas are expressed. Behavior that

450-454: A manic episode of bipolar disorder involves the utilization of either a mood stabilizer (e.g., carbamazepine , valproate , lithium , or lamotrigine ) or an atypical antipsychotic (e.g., olanzapine , quetiapine , risperidone , aripiprazole , or cariprazine ). More recently, substances such as iloperidone have been approved for the acute treatment of manic episodes related to bipolar I disorder . The use of antipsychotic agents in

525-404: A means of measuring attributes of a person or as a means of predicting scores on a criterion. While a reliable test may provide useful valid information, a test that is not reliable cannot possibly be valid. For example, if a set of weighing scales consistently measured the weight of an object as 500 grams over the true weight, then the scale would be very reliable, but it would not be valid (as

600-428: A non-mental medical illness (e.g., hyperthyroidism ), and: (a) is causing obvious difficulties at work or in social relationships and activities, or (b) requires admission to hospital to protect the person or others, or (c) the person has psychosis . To be classified as a manic episode, while the disturbed mood and an increase in goal-directed activity or energy is present, at least three (or four, if only irritability

675-432: A person could make them more engaging and outgoing, and cause them to have a positive outlook in life. When exaggerated in hypomania, however, such a person can display excessive optimism , grandiosity , and poor decision-making, often with little regard to the consequences. A single manic episode, in the absence of secondary causes, (i.e., substance use disorders , certain medications , or general medical conditions )

750-447: A reliable measure that is measuring something consistently is not necessarily measuring what you want to be measured. For example, while there are many reliable tests of specific abilities, not all of them would be valid for predicting, say, job performance. While reliability does not imply validity , reliability does place a limit on the overall validity of a test. A test that is not perfectly reliable cannot be perfectly valid, either as

825-454: A review and meta-analysis exploring this relationship found that this assumption may be too general and empirical research evidence is lacking. In hypomania, there is less need for sleep and both goal-motivated behaviour and metabolism increase. Some studies exploring brain metabolism in subjects with hypomania, however, did not find any conclusive link; while there are studies that reported abnormalities, some failed to detect differences. Though

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900-529: A role of dopamine in mania. Decreased cerebrospinal fluid levels of the serotonin metabolite 5-HIAA have been found in manic patients too, which may be explained by a failure of serotonergic regulation and dopaminergic hyperactivity. Limited evidence suggests that mania is associated with behavioral reward hypersensitivity, as well as with neural reward hypersensitivity. Electrophysiological evidence supporting this comes from studies associating left frontal EEG activity with mania. As left frontal EEG activity

975-1004: A state of abnormally elevated arousal , affect , and energy level. During a manic episode, an individual will experience rapidly changing emotions and moods, highly influenced by surrounding stimuli . Although mania is often conceived of as a "mirror image" to depression , the heightened mood can be dysphoric as well as euphoric . As the mania intensifies, irritability can be more pronounced and result in anxiety or anger . The symptoms of mania include elevated mood (either euphoric or irritable), flight of ideas , pressure of speech , increased energy, decreased "need" and desire for sleep, and hyperactivity . They are most plainly evident in fully developed hypomanic states, however, in full-blown mania, these symptoms become progressively exacerbated . In severe manic episodes, these symptoms may even be obscured by other signs and symptoms characteristic of psychosis , such as delusions, hallucinations, fragmentation of behavior, and catatonia . Mania

1050-960: Is antidepressant therapy. Studies show that the risk of switching while on an antidepressant is between 6-69 percent. Dopaminergic drugs such as reuptake inhibitors and dopamine agonists may also increase risk of switch. Other medications possibly include glutaminergic agents and drugs that alter the HPA axis . Lifestyle triggers include irregular sleep-wake schedules and sleep deprivation , as well as extremely emotional or stressful stimuli . Various genes that have been implicated in genetic studies of bipolar have been manipulated in preclinical animal models to produce syndromes reflecting different aspects of mania. CLOCK and DBP polymorphisms have been linked to bipolar in population studies, and behavioral changes induced by knockout are reversed by lithium treatment. Metabotropic glutamate receptor 6 has been genetically linked to bipolar, and found to be under-expressed in

1125-594: Is a brief (10-item) version of the PGBI that was validated for clinical use for patients presenting with a variety of different diagnoses, including frequent comorbid conditions. It is administered to parents for them to rate their children between ages 5–17. The 10 items include symptoms such as elated mood , high energy, irritability and rapid changes in mood and energy as indicators of potential juvenile bipolar disorder . The PhenX Toolkit uses this instrument as its child protocol for Hypomania/Mania Symptoms. One study had

1200-487: Is a syndrome with multiple causes. Although the vast majority of cases occur in the context of bipolar disorder , it is a key component of other psychiatric disorders (such as schizoaffective disorder , bipolar type) and may also occur secondary to various general medical conditions, such as multiple sclerosis ; certain medications may perpetuate a manic state, for example prednisone ; or substances prone to abuse, especially stimulants, such as amphetamine and cocaine . In

1275-410: Is defined in the American Psychiatric Association 's diagnostic manual (DSM) as a "distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration, if hospitalization is necessary)," where the mood is not caused by drugs/medication or

1350-531: Is euphoric or irritable), hypersensitivity, hypervigilance , hypersexuality, hyper-religiosity, hyperactivity and impulsivity, a compulsion to over explain (typically accompanied by pressure of speech), grandiose schemes and ideas, and a decreased need for sleep (for example, feeling rested after only 3 or 4 hours of sleep). In the case of the latter, the eyes of such patients may both look and seem abnormally "wide open", rarely blinking, and may contribute to some clinicians' erroneous belief that these patients are under

1425-546: Is generally thought to be a reflection of behavioral activation system activity, this is thought to support a role for reward hypersensitivity in mania. Tentative evidence also comes from one study that reported an association between manic traits and feedback negativity during receipt of monetary reward or loss. Neuroimaging evidence during acute mania is sparse, but one study reported elevated orbitofrontal cortex activity to monetary reward, and another study reported elevated striatal activity to reward omission. The latter finding

1500-504: Is important to manage symptoms of mania and depression, studies show relying on medications alone is not the most effective method of treatment. Medication is most effective when used in combination with other bipolar disorder treatments, including psychotherapy , self-help coping strategies, and healthy lifestyle choices. Lithium is the classic mood stabilizer to prevent further manic and depressive episodes. A systematic review found that long term lithium treatment substantially reduces

1575-425: Is not always the case that the clearly manic/hypomanic bipolar patient needs or wants medical help; such persons often either retain sufficient self-control to function normally or are unaware that they have "gone manic" severely enough to be committed or to commit themselves . Manic persons often can be mistaken for being under the influence of drugs . In a mixed affective state , the individual, though meeting

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1650-475: Is often sufficient to diagnose bipolar I disorder . Hypomania may be indicative of bipolar II disorder . Manic episodes are often complicated by delusions and/or hallucinations ; and if the psychotic features persist for a duration significantly longer than the episode of typical mania (two weeks or more), a diagnosis of schizoaffective disorder is more appropriate. Certain obsessive–compulsive spectrum disorders as well as impulse-control disorders share

1725-429: Is out-of-character and risky, foolish or inappropriate may result from a loss of normal social restraint. Some people also have physical symptoms, such as sweating , pacing, and weight loss . In full-blown mania, often the manic person will feel as though their goal(s) are of paramount importance, that there are no consequences, or that negative consequences would be minimal, and that they need not exercise restraint in

1800-414: Is present) of the following must have been consistently present: Though the activities one participates in while in a manic state are not always negative, those with the potential to have negative outcomes are far more likely. If the person is concurrently depressed, they are said to be having a mixed episode . The World Health Organization 's International Classification of Diseases (ICD) defines

1875-402: Is reasonable to assume that errors are equally likely to be positive or negative, and that they are not correlated with true scores or with errors on other tests. It is assumed that: 1. Mean error of measurement = 0 2. True scores and errors are uncorrelated 3. Errors on different measures are uncorrelated Reliability theory shows that the variance of obtained scores is simply the sum of

1950-481: Is reasonable to assume that the effect will not be as strong with alternate forms of the test as with two administrations of the same test. However, this technique has its disadvantages: 3. Split-half method : This method treats the two halves of a measure as alternate forms. It provides a simple solution to the problem that the parallel-forms method faces: the difficulty in developing alternate forms. It involves: The correlation between these two split halves

2025-417: Is that measurement errors are essentially random. This does not mean that errors arise from random processes. For any individual, an error in measurement is not a completely random event. However, across a large number of individuals, the causes of measurement error are assumed to be so varied that measure errors act as random variables. If errors have the essential characteristics of random variables, then it

2100-431: Is the overall consistency of a measure. A measure is said to have a high reliability if it produces similar results under consistent conditions: "It is the characteristic of a set of test scores that relates to the amount of random error from the measurement process that might be embedded in the scores. Scores that are highly reliable are precise, reproducible, and consistent from one testing occasion to another. That is, if

2175-472: Is used in estimating the reliability of the test. This halves reliability estimate is then stepped up to the full test length using the Spearman–Brown prediction formula . There are several ways of splitting a test to estimate reliability. For example, a 40-item vocabulary test could be split into two subtests, the first one made up of items 1 through 20 and the second made up of items 21 through 40. However,

2250-401: Is used to estimate the reliability of the test. This method provides a partial solution to many of the problems inherent in the test-retest reliability method . For example, since the two forms of the test are different, carryover effect is less of a problem. Reactivity effects are also partially controlled; although taking the first test may change responses to the second test. However, it

2325-610: Is used to promptly alleviate symptoms of agitation, aggression , and psychosis . Antidepressant monotherapy is not recommended for the treatment of depression in patients with bipolar disorders I or II, and no benefit has been demonstrated by combining antidepressants with mood stabilizers in these patients. Some atypical antidepressants , however, such as mirtazapine and trazodone , have been occasionally used after other options have failed. In Electroboy: A Memoir of Mania by Andy Behrman, he describes his experience of mania as "the most perfect prescription glasses with which to see

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2400-491: Is useful from a descriptive and differential diagnostic point of view. Mania varies in intensity, from mild mania ( hypomania ) to delirious mania, marked by such symptoms as disorientation, acute psychosis , incoherence, and catatonia . Standardized tools such as Altman Self-Rating Mania Scale and Young Mania Rating Scale can be used to measure severity of manic episodes. Because mania and hypomania have also long been associated with creativity and artistic talent, it

2475-671: The ICD-10 , there are several disorders with the manic syndrome: organic manic disorder ( F06.30 ), mania without psychotic symptoms ( F30.1 ), mania with psychotic symptoms ( F30.2 ), other manic episodes ( F30.8 ), unspecified manic episode ( F30.9 ), manic type of schizoaffective disorder ( F25.0 ), bipolar disorder , current episode manic without psychotic symptoms ( F31.1 ), bipolar affective disorder, current episode manic with psychotic symptoms ( F31.2 ). Before beginning treatment for mania, careful differential diagnosis must be performed to rule out secondary causes. The acute treatment of

2550-1373: The amygdala and other subcortical structures such as the ventral striatum tend to be increased, although results are inconsistent and likely dependent upon task characteristics such as valence. Reduced functional connectivity between the ventral prefrontal cortex and amygdala along with variable findings supports a hypothesis of general dysregulation of subcortical structures by the prefrontal cortex. A bias towards positively valenced stimuli , and increased responsiveness in reward circuitry may predispose towards mania. Mania tends to be associated with right hemisphere lesions, while depression tends to be associated with left hemisphere lesions. Post-mortem examinations of bipolar disorder demonstrate increased expression of Protein Kinase C (PKC). While limited, some studies demonstrate manipulation of PKC in animals produces behavioral changes mirroring mania, and treatment with PKC inhibitor tamoxifen (also an anti-estrogen drug) demonstrates antimanic effects. Traditional antimanic drugs also demonstrate PKC inhibiting properties, among other effects such as GSK3 inhibition. Manic episodes may be triggered by dopamine receptor agonists , and this combined with tentative reports of increased VMAT2 activity, measured via PET scans of radioligand binding , suggests

2625-648: The subthalamic nucleus in Parkinson's disease has been associated with mania, especially with electrodes placed in the ventromedial STN . A proposed mechanism involves increased excitatory input from the STN to dopaminergic nuclei. There are certain psychoactive substances that can induce a state of manic psychosis, including: amphetamine , cathinone , cocaine , MDMA , methamphetamine , methylphenidate , oxycodone , phencyclidine , designer drugs , etc. Mania can also be caused by physical trauma or illness . When

2700-520: The GBI used case scoring where items were given values ranging from 1–4. Symptoms that were rated as 1 or 2 were considered to be absent and symptoms rated as 3 or 4 were considered to be present. However, if each item were to receive one of four scores, the authors of the GBI decided Likert scaling would be a better scoring option. The items on the GBI are now scaled from 0–3 rated as 0 (never or hardly ever present), 1 (sometimes present), 2 (often present), and 3 (very often or almost constantly present). For

2775-402: The GBI, using the seven items that ask about anything directly related to sleep. The P-GBI is an adaptation of the GBI, consisting of 73 Likert scale items rated on a scale from 0 ("Never or Hardly Ever") to 3 ("Very often or Almost Constantly"). It consists of two scales: a depressive symptoms (46 items) and a hypomanic /biphasic (mixed) symptoms (28 items). Again, due to the length of

2850-464: The GBI. The 7 Up-7 Down ( 7U7D ) is a 14-item measure of manic and depressive tendencies that was carved from the full length GBI. This version is designed to be applicable for both youths and adults, and to improve separation between both mania and depressive conditions. It was developed via factor analysis from nine separate samples pooled into two age groups, ensuring applicability for use in youth and adults. A sleep scale also has been carved from

2925-501: The P-GBI as a reliable and valid measure of bipolar in children and adolescents. It is recommended to be used as part of an assessment battery in the diagnosis of juvenile bipolar disorder . The GBI is free for use clinically and in research. The reading level and length make it challenging for some people to complete. Mania Mania , also known as manic syndrome , is a psychiatric behavioral syndrome defined as

3000-495: The PGBI-10M, the scores from each question are added together to form a total score, with higher scores indicating a greater severity of symptoms. Scores range from 0 to 30. Low scores of 5 and below indicate a very low risk of a bipolar diagnosis. High scores of 18 and over indicate a high risk of a diagnosis of bipolar disorder, increasing the likelihood by a factor of seven or greater. Several peer-reviewed research studies support

3075-670: The ability to think clearly. Racing thoughts and misperceptions lead to frustration and decreased ability to communicate with others. Mania may also, as earlier mentioned, be divided into three "stages". Stage I corresponds with hypomania and may feature typical hypomanic characteristics, such as gregariousness and euphoria . In stages II and III mania, however, the patient may be extraordinarily irritable, psychotic or even delirious . These latter two stages are referred to as acute and delirious (or Bell's), respectively. Various triggers have been associated with switching from euthymic or depressed states into mania. One common trigger of mania

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3150-469: The absence of error. Errors of measurement are composed of both random error and systematic error . It represents the discrepancies between scores obtained on tests and the corresponding true scores. This conceptual breakdown is typically represented by the simple equation: The goal of reliability theory is to estimate errors in measurement and to suggest ways of improving tests so that errors are minimized. The central assumption of reliability theory

3225-417: The accuracy of measurement. The basic starting point for almost all theories of test reliability is the idea that test scores reflect the influence of two sorts of factors: 1. Consistency factors: stable characteristics of the individual or the attribute that one is trying to measure. 2. Inconsistency factors: features of the individual or the situation that can affect test scores but have nothing to do with

3300-423: The attribute being measured. These factors include: The goal of estimating reliability is to determine how much of the variability in test scores is due to measurement errors and how much is due to variability in true scores ( true value ). A true score is the replicable feature of the concept being measured. It is the part of the observed score that would recur across different measurement occasions in

3375-752: The causes are physical, it is called secondary mania . In some individuals, manic symptoms are also correlated with the season of spring. The mechanism underlying mania is unknown, but the neurocognitive profile of mania is highly consistent with dysfunction in the right prefrontal cortex , a common finding in neuroimaging studies. Various lines of evidence from post-mortem studies and the putative mechanisms of anti-manic agents point to abnormalities in GSK-3 , dopamine , Protein kinase C , and Inositol monophosphatase . Meta analysis of neuroimaging studies demonstrate increased thalamic activity, and bilaterally reduced inferior frontal gyrus activation. Activity in

3450-563: The concept of reliability from a single index to a function called the information function . The IRT information function is the inverse of the conditional observed score standard error at any given test score. The goal of estimating reliability is to determine how much of the variability in test scores is due to errors in measurement and how much is due to variability in true scores. Four practical strategies have been developed that provide workable methods of estimating test reliability. 1. Test-retest reliability method : directly assesses

3525-419: The cortex. Pituitary adenylate cyclase-activating peptide has been associated with bipolar in gene linkage studies, and knockout in mice produces mania like-behavior. Targets of various treatments such as GSK-3 , and ERK1 have also demonstrated mania like behavior in preclinical models. Mania may be associated with strokes, especially cerebral lesions in the right hemisphere. Deep brain stimulation of

3600-400: The current DSM-5 , hypomanic episodes are separated from the more severe full manic episodes, which, in turn, are characterized as either mild, moderate, or severe, with certain diagnostic criteria (e.g., catatonia , psychosis ). Mania is divided into three stages: hypomania, or stage I; acute mania, or stage II; and delirious mania ( delirium ), or stage III. This "staging" of a manic episode

3675-704: The degree to which test scores are consistent from one test administration to the next. It involves: The correlation between scores on the first test and the scores on the retest is used to estimate the reliability of the test using the Pearson product-moment correlation coefficient : see also item-total correlation . 2. Parallel-forms method : The key to this method is the development of alternate test forms that are equivalent in terms of content, response processes and statistical characteristics. For example, alternate forms exist for several tests of general intelligence, and these tests are generally seen equivalent. With

3750-406: The elevated mood and energy level typical of hypomania could be seen as a benefit, true mania itself generally has many undesirable consequences, including suicidal tendencies , and hypomania can, if the prominent mood is irritable as opposed to euphoric , be a rather unpleasant experience. In addition, the exaggerated case of hypomania can lead to problems. For instance, trait-based positivity for

3825-426: The flow of thoughts. Racing thoughts also interfere with the ability to fall asleep. Manic states are always relative to the normal state of intensity of the affected individual; thus, already irritable patients may find themselves losing their tempers even more quickly, and an academically gifted person may, during the hypomanic stage, adopt seemingly "genius" characteristics and an ability to perform and articulate at

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3900-405: The full version, several short forms have been built and tested in multiple samples that may be more convenient to use in clinical work. These include 10 item mania, two alternate 10 item depression forms, and the seven item Sleep scale. All have performed as well or better than the self-report version when completed by an adult familiar with the youth's behavior (typically a parent). The PGBI-10M

3975-405: The general criteria for a hypomanic (discussed below) or manic episode, experiences three or more concurrent depressive symptoms. This has caused some speculation, among clinicians , that mania and depression, rather than constituting "true" polar opposites, are, rather, two independent axes in a unipolar—bipolar spectrum. A mixed affective state, especially with prominent manic symptoms, places

4050-440: The individual's lack of judgment and insight regarding periods of exacerbation of characteristic states. Manic patients are frequently grandiose, obsessive, impulsive, irritable, belligerent, and frequently deny anything is wrong with them. Because mania frequently encourages high energy and decreased perception of need or ability to sleep, within a few days of a manic cycle, sleep-deprived psychosis may appear, further complicating

4125-686: The influence of a stimulant drug, when the patient, in fact, is either not on any mind-altering substances or is actually on a depressant drug. Individuals may also engage in out-of-character behavior during the episode, such as questionable business transactions, wasteful expenditures of money (e.g., spending sprees), risky sexual activity, abuse of recreational substances, excessive gambling, reckless behavior (such as extreme speeding or other daredevil activity), abnormal social interaction (e.g., over-familiarity and conversing with strangers), or highly vocal arguments. These behaviours may increase stress in personal relationships, lead to problems at work, and increase

4200-454: The internal consistency reliability was high. The results suggested that it was challenging for teachers to tell the difference between hypomanic symptoms and symptoms attributable to attention-deficit/hyperactivity disorder , which is much more common in the classroom. The results aligned with findings from a large meta-analysis that teacher report had the lowest average validity across all mania scales compared to adolescent or parent report on

4275-471: The manic side of his condition has had positive contributions on his life. The nosology of the various stages of a manic episode has changed over the decades. The word derives from the Ancient Greek μανία ( manía ), "madness, frenzy" and the verb μαίνομαι ( maínomai ), "to be mad, to rage, to be furious." Reliability (psychometrics) In statistics and psychometrics , reliability

4350-525: The methods to estimate reliability include test-retest reliability , internal consistency reliability, and parallel-test reliability . Each method comes at the problem of figuring out the source of error in the test somewhat differently. It was well known to classical test theorists that measurement precision is not uniform across the scale of measurement. Tests tend to distinguish better for test-takers with moderate trait levels and worse among high- and low-scoring test-takers. Item response theory extends

4425-422: The parallel test model it is possible to develop two forms of a test that are equivalent in the sense that a person's true score on form A would be identical to their true score on form B. If both forms of the test were administered to a number of people, differences between scores on form A and form B may be due to errors in measurement only. It involves: The correlation between scores on the two alternate forms

4500-442: The patient at a greater risk for suicide . Depression on its own is a risk factor but, when coupled with an increase in energy and goal-directed activity, the patient is far more likely to act with violence on suicidal impulses. Hypomania , which means "less than mania", is a lowered state of mania that does little to impair function or decrease quality of life. Although creativity and hypomania have been historically linked,

4575-432: The pursuit of what they are after. Hypomania is different, as it may cause little or no impairment in function. The hypomanic person's connection with the external world, and its standards of interaction, remain intact, although intensity of moods is heightened. But those with prolonged unresolved hypomania do run the risk of developing full mania, and may cross that "line" without even realizing they have done so. One of

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4650-406: The reliability coefficient is defined as the ratio of true score variance to the total variance of test scores. Or, equivalently, one minus the ratio of the variation of the error score and the variation of the observed score : Unfortunately, there is no way to directly observe or calculate the true score, so a variety of methods are used to estimate the reliability of a test. Some examples of

4725-415: The responses from the first half may be systematically different from responses in the second half due to an increase in item difficulty and fatigue. In splitting a test, the two halves would need to be as similar as possible, both in terms of their content and in terms of the probable state of the respondent. The simplest method is to adopt an odd-even split, in which the odd-numbered items form one half of

4800-421: The returned weight is not the true weight). For the scale to be valid, it should return the true weight of an object. This example demonstrates that a perfectly reliable measure is not necessarily valid, but that a valid measure necessarily must be reliable. In practice, testing measures are never perfectly consistent. Theories of test reliability have been developed to estimate the effects of inconsistency on

4875-495: The risk of altercations with law enforcement. There is a high risk of impulsively taking part in activities potentially harmful to the self and others. Although "severely elevated mood" sounds somewhat desirable and enjoyable, the experience of mania is ultimately often quite unpleasant and sometimes disturbing, if not frightening, for the person involved and for those close to them, and it may lead to impulsive behaviour that may later be regretted. It can also often be complicated by

4950-468: The risk of bipolar manic relapse, by 42%. Anticonvulsants such as valproate , oxcarbazepine , and carbamazepine are also used for prophylaxis . More recent drug solutions include lamotrigine and topiramate , both anticonvulsants as well. In some cases, long-acting benzodiazepines , particularly clonazepam , are used after other options are exhausted. In more urgent circumstances, such as in emergency rooms, lorazepam , combined with haloperidol ,

5025-575: The same scales. Based on these results, current recommendations are to concentrate on parent and youth report, and not use teacher report as a way of measuring hypomanic symptoms in youths. The GBI has been used extensively in research, including clinical samples, college students, longitudinal, treatment, and other studies. However, no normative data exist to calibrate scores in the general population. The GBI has very good reliability. The current GBI questionnaire includes 73 Likert-type items which reflect symptoms of different moods. The original version of

5100-417: The signature symptoms of mania (and to a lesser extent, hypomania ) is what many have described as racing thoughts . These are usually instances in which the manic person is excessively distracted by objectively unimportant stimuli. This experience creates an absent-mindedness where the manic individual's thoughts totally preoccupy them, making them unable to keep track of time, or be aware of anything besides

5175-653: The suffix "-mania," namely, kleptomania , pyromania , and trichotillomania . Despite the unfortunate association implied by the name, however, no connection exists between mania or bipolar disorder and these disorders. Furthermore, evidence indicates a vitamin B 12 deficiency can also cause symptoms characteristic of mania and psychosis. Hyperthyroidism can produce similar symptoms to those of mania, such as agitation, elevated mood, increased energy, hyperactivity, sleep disturbances and sometimes, especially in severe cases, psychosis. Postpartum psychosis can also cause manic episodes ( unipolar mania ). A manic episode

5250-488: The testing process were repeated with a group of test takers, essentially the same results would be obtained. Various kinds of reliability coefficients, with values ranging between 0.00 (much error) and 1.00 (no error), are usually used to indicate the amount of error in the scores." For example, measurements of people's height and weight are often extremely reliable. There are several general classes of reliability estimates: Reliability does not imply validity . That is,

5325-451: The treatment of acute mania was reviewed by Tohen and Vieta in 2009. When the manic behaviours have gone, long-term treatment then focuses on prophylactic treatment to try to stabilize the patient's mood, typically through a combination of pharmacotherapy and psychotherapy . The likelihood of having a relapse is very high for those who have experienced two or more episodes of mania or depression. While medication for bipolar disorder

5400-475: The variance of true scores plus the variance of errors of measurement . This equation suggests that test scores vary as the result of two factors: 1. Variability in true scores 2. Variability due to errors of measurement. The reliability coefficient ρ x x ′ {\displaystyle \rho _{xx'}} provides an index of the relative influence of true and error scores on attained test scores. In its general form,

5475-486: The world... life appears in front of you like an oversized movie screen." Behrman indicates early in his memoir that he sees himself not as a person with an uncontrollable disabling illness, but as a director of the movie that is his vivid and emotionally alive life. There is some evidence that people in the creative industries have bipolar disorder more often than those in other occupations. Winston Churchill had periods of manic symptoms that may have been both an asset and

5550-412: Was increased to 73, with the final version having 73 mood items and 6 additional questions to check the validity of responses (but which did not figure in the scale scores). The self report version of the GBI has been used in an extensive program of research, accruing evidence of many facets of validity. Because of its length and high reading level, there also have been many efforts to develop short forms of

5625-452: Was interpreted in the context of either elevated baseline activity (resulting in a null finding of reward hypersensitivity), or reduced ability to discriminate between reward and punishment, still supporting reward hyperactivity in mania. Punishment hyposensitivity , as reflected in a number of neuroimaging studies as reduced lateral orbitofrontal response to punishment, has been proposed as a mechanism of reward hypersensitivity in mania. In

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