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Area of Science:

  • Psychiatry
  • Behavioral Science
  • Clinical Psychology

Background:

  • The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) identifies increased activity and energy as cardinal symptoms of mania and hypomania.
  • While research suggests the validity of 'activation' as a symptom, a systematic integration of evidence has been lacking.
  • Activation is conceptualized as a phenomenon stemming from physiological changes, encompassing both observable motor activity and subjective energy levels.

Purpose of the Study:

  • To systematically review studies on the clinical phenomenon of activation in bipolar disorder.
  • To determine if activation is statistically abnormal and distinct from mood in bipolar disorder.
  • To identify differences in activation dynamics within and between individuals with bipolar disorder.

Main Methods:

  • A systematic review of multiple databases (MEDLINE, PsycINFO, EMBASE, CINAHL, PubMed) from 1970 to 2016.
  • Included data-driven analyses of mania/bipolar depression dimensions and longitudinal studies with objective activity monitoring.
  • Incorporated gray literature and researcher contact to ensure comprehensive data inclusion.

Main Results:

  • Fifty-six studies met eligibility criteria, including factor structure analyses, ecological momentary assessment, and actigraphy studies.
  • Patients with bipolar disorder exhibit lower mean activity levels during euthymia and depression compared to controls.
  • Activation and mood appear to be distinct dimensions; mania may be characterized by activation variability rather than just mean levels.

Conclusions:

  • The findings broadly support the inclusion of activation as a Criterion A symptom for bipolar disorder in DSM-5.
  • Despite historical acknowledgment, activation remains an understudied construct in bipolar disorder.
  • High-quality, systematic research on activation is crucial for advancing our understanding and treatment of bipolar disorder.