{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:54:02Z","timestamp":1784310842402,"version":"3.55.0"},"reference-count":76,"publisher":"Cambridge University Press (CUP)","issue":"15","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0033291723000831_sec_a1\"><jats:title>Background<\/jats:title><jats:p>The diagnostic concept of unipolar mania (UM), i.e. the lifetime occurrence of mania without major depressive episodes, remains a topic of debate despite the evidence accumulated in the last few years. We carried out a systematic review and meta-analysis of observational studies testing factors associated with UM as compared to bipolar disorder with a manic-depressive course (md-BD).<\/jats:p><\/jats:sec><jats:sec id=\"S0033291723000831_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>Studies indexed up to July 2022 in main electronic databases were searched. Random-effects meta-analyses of the association between UM and relevant correlates yielded odds ratio (OR) or standardized mean difference (SMD), with 95% confidence intervals (CIs).<\/jats:p><\/jats:sec><jats:sec id=\"S0033291723000831_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Based on data from 21 studies, factors positively or negatively associated with UM, as compared to md-BD, were: male gender (OR 1.47; 95% CI 1.11\u20131.94); age at onset (SMD \u22120.25; 95% CI \u22120.46 to \u22120.04); number of hospitalizations (SMD 0.53; 95% CI 0.21\u20130.84); family history of depression (OR 0.55; 95% CI 0.36\u20130.85); suicide attempts (OR 0.25; 95% CI 0.19\u20130.34); comorbid anxiety disorders (OR 0.35; 95% CI 0.26\u20130.49); psychotic features (OR 2.16; 95% CI 1.55\u20133.00); hyperthymic temperament (OR 1.99; 95% CI 1.17\u20133.40). The quality of evidence for the association with previous suicide attempts was high, moderate for anxiety disorders and psychotic features, and low or very low for other correlates.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291723000831_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Despite the heterogeneous quality of evidence, this work supports the hypothesis that UM might represent a distinctive diagnostic construct, with peculiar clinical correlates. Additional research is needed to better differentiate UM in the context of affective disorders, favouring personalized care approaches.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291723000831","type":"journal-article","created":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T06:39:10Z","timestamp":1680676750000},"page":"7277-7286","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":13,"title":["Characterizing the clinical profile of mania without major depressive episodes: a systematic review and meta-analysis of factors associated with unipolar 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