an
algorithm has been constructed that yields a positive
predictive value of 0.92 (30). The diagnoses of acute mania
have not been validated. Nevertheless, the outcome of interest
in this study—a diagnosis of acute mania in a patient
with known bipolar disorder—is likely to be reasonably valid.
It should be noted, however, that this outcome captures the
severe end of the mania spectrum, where symptoms lead to
an outpatient visit or a hospitalization; milder hypomanias
that do not lead to contact with the health care system will
not be captured in this study.