Depressive elements were observed on a quantitative behavioral rating scale during manic episodes in 28 of 30 patients, suggesting that most manic patients manifest a "mixed" manic-depressive picture. A factor analysis of the scale confirmed a "core" group of manic symptoms as well as a dichotomous grouping of elated-grandiose (E-G) and paranoid-destructive (P-D) patients. It also suggested a close relationship between the presence of rated depression during mania and the particular symptomatic complex found in the P-D subgroup of manic patients.
Elation ratings were not significantly correlated with total mania scale ratings in all, but only in the subgroup of E-G patients. These differences had apparent relationships to therapeutic responses to lithium carbonate; manic patients in the E-G subgroup responded more frequently than did patients in the P-D subgroup.