Establishing diagnostic criteria for mania.

There has been general agreement on the symptoms of mania, but the validity of criteria for diagnosing mania have not been studied. The present study evaluates diagnostic criteria for mania by examining their internal construct validity, i.e., whether they are consistent with structure implicit in the concept of diagnostic criteria. Symptom information from 235 patients with varying diagnoses were studied. Elevated, expansive, or irritable mood, hyperactivity, and rapid or pressured speech were found to define a diagnostic classification of mania. Grandiosity and flight of ideas were related to this classification but did not contribute to its definition. Results suggested new diagnostic criteria for mania, with patients being diagnosed manic if they had at least two of the three designated symptoms. Additional information on the presence or absence of grandiosity and/or flight of ideas changed the diagnoses of only seven patients (3 per cent), all of whom had had the lowest certainty of diagnosis based on three symptoms. The entire study was replicated on an independent sample of 182 patients with nearly identical results.