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

PrefaceBipolar disorders have a long history. Mania and melancholia are the oldest termsand descriptions within psychiatry, having been created in Homeric times by theGreeks, and conceptualized by Hippocrates and his school 2500 years ago. Aretaeusof Cappadocia put melancholia and mania together, because he recognized bothpsychopathological states as parts of the same disease, thereby giving birth to thebipolar disorders. His formulation stressed that, while mania has various phenomenologicalmanifestations, nevertheless all of these forms belong to the samedisease. Some of these special forms of bipolar disorder that are of major clinicaland research relevance are the topic of this book.Even though the three groups of bipolar disorders – mixed states, rapid-cycling,and atypical bipolar disorder – were well known by the nineteenth century, interestaccelerated after the psychopharmacological revolution in the middle of thetwentieth century. Thus the importance of defining rapid cycling was made clearby the observation that the response to lithium treatment was poorer in patientsexperiencing four or more episodes per year. The ‘‘rediscovery’’ of mixed states,which were conceptualized by Emil Kraepelin and Wilhelm Weygandt at the endof the nineteenth century, was also associated with problems concerning treatmentwith antidepressants and mood stabilizers. It has been half a century since the startof the pharmacological revolution. Its consequences across all fields of psychiatryhave been enormous: biological research and genetics, treatment and prophylaxis,clinical and prognostic research, and psychopathological and diagnosticapproaches. Furthermore, the way our culture views mental illness has beenprofoundly influenced by this revolution, and the lives of our patients are muchbetter for it.This book synthesizes valuable knowledge from the past, integrates it with newinsights from the modern era, and looks to the future of mixed states, rapidcycling,and atypical bipolar disorders. The editors would like to thank all contributorsand supporters, especially Lilly Germany, for supporting this edition.xi