Bipolar Disorders. 100 Years after Manic-Depressive Insanity

Bipolar Disorders. 100 Years after Manic-Depressive Insanity

Andreas Marneros, Jules Angst

Language: English

Pages: 502

ISBN: 9048155673

Format: PDF / Kindle (mobi) / ePub

Bipolar Disorders. 100 Years after Manic-Depressive Insanity

Andreas Marneros, Jules Angst

Language: English

Pages: 502

ISBN: 9048155673

Format: PDF / Kindle (mobi) / ePub


One hundred years ago - in 1899 - Emil Kraepelin, Professor of Psychiatry in Heidelberg and later in Munich - created, in two very important pieces of work, the concept of "manisch-depressives Irresein" ("manic-depressive insanity"). The first was entitled Die klinische Stellung der Melancholie(The Clinical Position of Melancholia), and the second publication was the sixth edition of his textbook. In the same year Kraepelin's pupil and colleague, Wilhelm Weygandt, published his book Uber die Mischzustande des Manisch- Depressiven Irreseins (On the Mixed States of Manic-Depressive Insanity). A century after Kraepelin's creation of "manic-depressive insanity", we celebrate. Is this really appropriate? We believe it is firmly established that the "folie circulaire" of Jean-Pierre Falret or the "folie a double forme" of Jules Baillarger differs from recurrent depression, which is also different from Kraepelin's "manic-depressive insanity". Yet the answer to the question of xvi Preface whether it is appropriate to celebrate is clear: Yes. This not only because the work of Emil Kraepelin is fundamental in the true sense of the word. There can be no doubt that Emil Kraepelin is the most important founder of modern psychiatry. Just one of the many reasons for this opinion is his enormous contribution to the definition, description and diagnosis of affective disorders.

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1987, see also Marneros 2000b). Kraepelin suggested a mixing of manic or depressive symptoms with cyclothymic, hyperthymic or depressive temperament. The mixing of symptoms and temperament created, in Akiskal's opinion, three different types of mixed states: Type I: depressive temperament + psychosis Type II: cyclothymic temperament + depression Type III: hyperthymic temperament + depression In the past two decades a "mixed type of schizoaffective disorders" has also been described, which is a

substantial data suggest lithium may be less effective in the short- and possibly long-term treatment of mixed mania than it is in pure mania. Valproate, ECT, and possibly atypical antipsychotics (especially clozapine and olanzapine) may be more effective for these patients, though further comparative studies are needed. Of note, Bowden (1995) has argued that the relatively poor response of patients with mixed mania to lithium may be due to the limited spectrum of efficacy of lithium rather than

Depression, elation, and lithium carbonate responses in manic patient subgroups. Arch Gen Psychiatry. 1974;31(5):643–8. Musalek M, Lesch OM, Kieffer W. Dysphoric states in the course of manic-depressive illness. Psychopathology. 1987;20:107–14. Nunn CMH. Mixed affective states and the natural history of manic-depressive psychosis. Br J Psychiatry. 1979;134:153–60. Perugi G, Akiskal HS, Micheli C el al. Clinical subtypes of bipolar mixed states: validating a broader European definition in 143

between the unipolar and bipolar schizoaffective disorders. We could find no differences, however, concerning long-term outcome, neither between unipolar and bipolar affective disorders nor between unipolar and bipolar schizoaffective disorders (if we consider only the same number of episodes). Comparison of bipolar affective and bipolar schizoaffective disorders showed no differences in any important sociodemographic and premorbid features (Marneros et al. 1991) (see Table 5). As Table 6 shows,

unipolar manics experienced an age at onset significantly lower (mean 41 years) compared to "bipolar" elderly patients who had a mean onset of 65 years. Thus, elderly unipolar manic patients are amongst the very few elderly bipolars whose illness begins early in life. This difference suggests that there may be variations in genetic vulnerability and pathogenesis between these subgroups that merit further investigation. Emphasis should be placed on the fact that this involves a study of

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