{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T04:17:24Z","timestamp":1759033044162},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2009,8,5]],"date-time":"2009-08-05T00:00:00Z","timestamp":1249430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Psychology and Psychoth"],"published-print":{"date-parts":[[2009,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Objectives: Conventional descriptions of bipolar disorder tend to treat the mixed state as something of an afterthought. There is no scale that specifically measures the phenomena of the mixed state. This study aimed to test a novel scale for mixed state in a clinical and community population of bipolar patients. Methods: The scale included clinically relevant symptoms of both mania and depression in a bivariate scale. Recovered respondents were asked to recall their last manic episode. The scale allowed endorsement of one or more of the manic and depressive symptoms. Internal consistency analyses were carried out using Cronbach alpha. Factor analysis was carried out using a standard Principal Components Analysis followed by Varimax Rotation. A confirmatory factor analytic method was used to validate the scale structure in a representative clinical sample. Results: The reliability analysis gave a Cronbach alpha value of 0.950, with a range of corrected\u2010item\u2010total\u2010scale correlations from 0.546 (weight change) to 0.830 (mood). The factor analysis revealed a two\u2010factor solution for the manic and depressed items which accounted for 61.2% of the variance in the data. Factor 1 represented physical activity, verbal activity, thought processes and mood. Factor 2 represented eating habits, weight change, passage of time and pain sensitivity. Conclusions: This novel scale appears to capture the key features of mixed states. The two\u2010factor solution fits well with previous models of bipolar disorder and concurs with the view that mixed states may be more than the sum of their parts. Copyright \u00a9 2009 John Wiley &amp; Sons, Ltd.<\/jats:p><jats:p><jats:bold>Key Practitioner Message:<\/jats:bold>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>There is no clinical scale that specifically measures the phenomena of the bipolar mixed state. This new scale includes clinically relevant symptoms of both mania and depression in a bivariate scale. The scale appears to capture key features of the mixed state and endorses the view that mixed states may be more than the sum of their parts.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p>","DOI":"10.1002\/cpp.633","type":"journal-article","created":{"date-parts":[[2009,8,5]],"date-time":"2009-08-05T10:02:48Z","timestamp":1249466568000},"page":"497-509","source":"Crossref","is-referenced-by-count":18,"title":["A novel scale for measuring mixed states in bipolar disorder"],"prefix":"10.1002","volume":"16","author":[{"given":"Jonathan","family":"Cavanagh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Schwannauer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mick","family":"Power","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy M.","family":"Goodwin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,8,5]]},"reference":[{"key":"e_1_2_1_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02294359"},{"issue":"2","key":"e_1_2_1_3_1","doi-asserted-by":"crossref","first-page":"4S","DOI":"10.1097\/00004714-199604001-00002","article-title":"The prevalent clinical spectrum of bipolar disorders: Beyond DSM\u2010IV","volume":"16","author":"Akiskal H.S.","year":"1996","journal-title":"Journal of Clinical Psychopharmacology"},{"key":"e_1_2_1_4_1","volume-title":"DSM\u2010IV","author":"American Psychiatric Association","year":"1994"},{"key":"e_1_2_1_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1991.01810330031005"},{"key":"e_1_2_1_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1971.01750150064009"},{"key":"e_1_2_1_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(01)00444-X"},{"key":"e_1_2_1_8_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.107.2.238"},{"key":"e_1_2_1_9_1","volume-title":"EQS structural equations program manual","author":"Bentler P.","year":"1995"},{"key":"e_1_2_1_10_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.psych.47.1.563"},{"key":"e_1_2_1_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(02)00265-3"},{"key":"e_1_2_1_12_1","first-page":"320p","volume-title":"Eds.), Testing structural equation models. Sage focus","author":"Browne M.W.","year":"1993"},{"key":"e_1_2_1_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-69129-4_11"},{"key":"e_1_2_1_14_1","first-page":"265","volume-title":"Psychopathology and the brain","author":"Carroll B.J.","year":"1991"},{"issue":"2","key":"e_1_2_1_15_1","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1093\/clinchem\/40.2.303","article-title":"Brain mechanisms in manic depression","volume":"40","author":"Carroll B.J.","year":"1994","journal-title":"Clinical Chemistry"},{"key":"e_1_2_1_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.55.1.27"},{"key":"e_1_2_1_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/0010-440X(88)90023-5"},{"key":"e_1_2_1_18_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.114.517.1523"},{"key":"e_1_2_1_19_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2008.08030322"},{"key":"e_1_2_1_20_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2008.08050746"},{"key":"e_1_2_1_21_1","volume-title":"Manic\u2010depressive illness","author":"Goodwin F.K.","year":"1990"},{"issue":"3","key":"e_1_2_1_22_1","first-page":"613","article-title":"Sources of lithium resistance in mixed mania","volume":"22","author":"Himmelhoch J.M.","year":"1986","journal-title":"Psychopharmacology Bulletin"},{"key":"e_1_2_1_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1974.01760160005001"},{"key":"e_1_2_1_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540260500064744"},{"key":"e_1_2_1_25_1","volume-title":"Manic\u2010depressive insanity and paranoia","author":"Kraepelin E.","year":"2002"},{"key":"e_1_2_1_26_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.149.12.1633"},{"key":"e_1_2_1_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1989.01810040059009"},{"key":"e_1_2_1_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/0165-0327(88)90003-1"},{"key":"e_1_2_1_29_1","first-page":"432p","volume-title":"Latent variables analysis : Applications for developmental research","author":"Satorra A.","year":"1994"},{"key":"e_1_2_1_30_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2008.08111669"},{"key":"e_1_2_1_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/0165-0327(85)90033-3"},{"key":"e_1_2_1_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/0165-0327(93)90036-J"},{"key":"e_1_2_1_33_1","volume-title":"Using multivariate statistics","author":"Tabachnick B.G.","year":"2001"},{"key":"e_1_2_1_34_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1990.01810240026005"},{"key":"e_1_2_1_35_1","first-page":"105","article-title":"Ueber das manisch\u2010depressive Irresein","volume":"4","author":"Weygandt W.","year":"1901","journal-title":"Berliner Klinischer Wochenschrift"},{"key":"e_1_2_1_36_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.125.11.1491"},{"key":"e_1_2_1_37_1","volume-title":"Manic depressive illness","author":"Winokur G.","year":"1969"},{"key":"e_1_2_1_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1994.tb01499.x"}],"container-title":["Clinical Psychology &amp; Psychotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcpp.633","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cpp.633","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T18:31:06Z","timestamp":1700073066000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cpp.633"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,8,5]]},"references-count":37,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2009,11]]}},"alternative-id":["10.1002\/cpp.633"],"URL":"https:\/\/doi.org\/10.1002\/cpp.633","archive":["Portico"],"relation":{},"ISSN":["1063-3995","1099-0879"],"issn-type":[{"value":"1063-3995","type":"print"},{"value":"1099-0879","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,8,5]]}}}