Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

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92 E. Vieta et al.Table 4.2 Differential qualitative features between bipolar I and bipolar II disorderBipolar IBipolar IIVariable No. % No. % 2 PSex 2.03 NSMale 17 45 5 23Female 21 55 17 77Marital statusNASingle 22 58 8 36Married 11 29 12 55Separated 4 10 0 0Widowed 1 3 2 9First episode 0.13 NSManic/hypomanic 17 45 8 36Depressive 21 55 14 64Rapid cycling 0.35 NSPresent 5 13 5 23Absent 33 87 17 77Seasonal pattern 0.21 NSPresent 17 45 12 55Absent 21 55 10 45Psychotic symptoms 11.64
93 Bipolar I and bipolar II: a dichotomy?we analyze all these data, it is essential to consider the influence of treatmentbecause many patients, before being diagnosed as bipolar II, could have beenmisdiagnosed as personality disorders or unipolar depressive disorder, whichwould have precluded the use of mood stabilizers that facilitated treatment withtryciclic antidepressants, with a high risk of drug-induced switching (Vieta, 1999).Figure 4.1 illustrates the natural course of some bipolar I and bipolar II patientswhen antidepressant use was strictly controlled and all patients received moodstabilizers.Coryell et al. (1987, 1995) reported that bipolar II disorder seemed to bephenomenologically stable, with a relatively low percentage of patients whobecame bipolar I during follow-up. This would support the long-term validity ofthe bipolar II category and the hypothesis of a true dichotomy. Akiskal et al.(1995)performed an 11-year follow-up of a sample who presented a major depressiveepisode. The results showed that 3.9% developed a full-blown manic episode,becoming bipolar type I, and 8.6% presented with at least one episode of hypomania,confirming that they belonged to bipolar II disorder. Unipolar patientswho switched to bipolar II disorder were characterized by early age at onset,recurrent depression, high rates of divorce or separation, high rates of scholasticand/or job maladjustment, isolated antisocial acts, drug abuse, and a broadmélange of atypical depressive symptoms with borderline taint. Mood labilitywas the most specific predictor of which depressions would prospectively switchto bipolar II disorder. The study testifies to the fact that bipolar II disorder is acomplex affective disorder with biographical instability deriving from an intensetemperamental dysregulation (Akiskal, 2002a, b). Other authors have suggestedthat the depressive phase of bipolar II disorder features more atypical symptomsthan unipolar depression (Benazzi, 2000). Akiskal et al. (1983) proposed eightcriteria that are believed to be predictive of ‘‘bipolarization’’ from depression:(1) treatment-induced hypomania; (2) family history of bipolar disorder; (3) stronginheritability; (4) depression with hypersomnia and motor slowing-down;Patients inremission(%)1008060402000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24Bipolar IBipolar IIFig. 4.1 Course of bipolar I and bipolar II disorders. Reproduced with permission from Vieta (1999).
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Bipolar DisordersMixed States, Rapi
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ContentsList of contributorsPreface
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ContributorsValadeta Ajdacic PhDPsy
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ixList of contributorsAlexia E. Kou
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PrefaceBipolar disorders have a lon
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2 A. Marneros and F. K. Goodwinold
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4 A. Marneros and F. K. GoodwinFig.
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6 A. Marneros and F. K. GoodwinThe
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8 A. Marneros and F. K. GoodwinFig.
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26 A. Marneros and F. K. Goodwinbou
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28 A. Marneros and F. K. GoodwinAno
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30 A. Marneros and F. K. GoodwinTab
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32 A. Marneros and F. K. GoodwinBip
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38 A. Marneros and F. K. GoodwinAki
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40 A. Marneros and F. K. GoodwinDil
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Page 73 and 74: 59 Longitudinal perspective of mixe
Page 75 and 76: 3Rapid-cycling bipolar disorder1 2O
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Page 101 and 102: 87 Rapid-cycling bipolar disorderde
Page 103 and 104: 89 Bipolar I and bipolar II: a dich
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Page 115 and 116: 101 Bipolar I and bipolar II: a dic
Page 123 and 124: 5Recurrent brief depression as an i
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Page 135 and 136: 121 Recurrent brief depressionTable
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Page 143 and 144: 129 Recurrent brief depressionMarne
Page 145 and 146: 6Atypical depression and its relati
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143 Atypical depression and bipolar
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7Agitated depression: spontaneous a
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159 Agitated depression: spontaneou
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8Schizoaffective mixed statesAndrea
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189 Schizoaffective mixed statescon
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191 Schizoaffective mixed stateswas
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193 Schizoaffective mixed statesUni
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195 Schizoaffective mixed statesTab
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197 Schizoaffective mixed statesday
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199 Schizoaffective mixed statesTot
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201 Schizoaffective mixed statesBip
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203 Schizoaffective mixed statesThe
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205 Schizoaffective mixed statesMar
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9Acute and transient psychotic diso
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209 Acute and transient psychotic d
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Table 9.10 (cont.)ATPD(n ¼ 39)Bipo
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Table 9.11 (cont.)Bipolar affective
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Table 9.14b Significant differences
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10Bipolar disorder in children and
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239 Bipolar disorder in children an
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Pellegrini et al. (1986) 16 23 (7-1
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253 Atypical features of bipolarity
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12Comorbidity in mixed states and r
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265 Comorbidity in mixed states and
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13Challenges in the genetics of bip
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279 Challenges in the genetics of b
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Table 13.1 Proportion of first-degr
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Table 13.3 Summary of recent bipola
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13q32 = 3.321q22 = 3.6Liu, C.et al.
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14Biological aspects of rapid cycli
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313 Rapid cycling and mixed statesa
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315 Rapid cycling and mixed statesa
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317 Rapid cycling and mixed statesi
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319 Rapid cycling and mixed statesC
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321 Rapid cycling and mixed statesJ
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323 Rapid cycling and mixed statesW
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325 The treatment of bipolar mixed
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16The use of atypical antipsychotic
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355 Use of atypical antipsychotic a
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17Investigational strategies: treat
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371 Investigational strategiesBIPOL
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373 Investigational strategiesinsta
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375 Investigational strategiesWhat
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377 Investigational strategiesTable
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379 Investigational strategiescateg
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381 Investigational strategiesTable
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383 Investigational strategies2. Th
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385 Investigational strategiesSachs
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387 Indexclinical course and outcom
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389 Indexdepressive mixed states 51
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391 IndexLange, J. 163learning disa
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393 Indexpsychopharmacological revo
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395 Indexmania, acute 334mixed stat
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Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

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