Manic episodes, which are mandatory for the diagnosis of bipolar disorder, are traditionally viewed as "mood episodes."1 It has been proposed that variables related to activation level, and not to mood state, constitute the core characteristics of the manic syndrome.2
As exact phenotype characterization is crucial for the identification of biological and genetic markers, the available diagnoses systems may be insufficient. In a recent article Cassidy et al3 describe the symptom structure of mania identifying dysphoria, psychomotor acceleration, psychosis, increased hedonic function, and irritable aggression as separate factors in a sample of 237 bipolar subjects. They point out the substantial lack of empirical studies supporting the psychopathological definition of manic states.4,5 Therefore, a replication on a large sample is needed.
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