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

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186 A. Koukopoulos et al.Swann, A. C., Secunda, S. K., Kalz, M. M. et al. (1993). Specificity of mixed affective states:clinical comparison of dysphoric mania and agitated depression. J. Affect. Disord.,28, 81–9.Teicher, M. H., Glod, C., Cole, J. O. et al. (1990). Emergence of intense suicidal preoccupationduring fluoxetine treatment. Am. J. Psychiatry, 147, 207–10.Thalbitzer, S. (1908). Die manisch-depressive Psychose: das Stimmungs-irresein. Arch.Psychiatr. Nervenkr., 43, 1071–127.Weitbrecht, H. J. (1963). Psychiatrie in Grundriss. Berlin: Springer.Wernicke, C. (1906). Grundriss der Psychiatrie. Berlin: G. Thieme.Westphal, A. and Koeplin O. (1907). Bemerkungen zu dem Aufsatze von Prof. Dr. G. Specht:ueber den Angstaffekt im manisch-depessiven Irresein. Zentralbl. Nervenheilkr. Psych., 18,729–31.Weygandt, W. (1899). Ueber die Mischzustaende des manisch-depressiven Irreseins. Munich:Lehmann.World Health Organization (1992). ICD-10: International Statistical Classification of Diseasesand Related Health Problems, 10th revision. Geneva: World Health Organization.Ziehen, T. (1902). Psychiatrie. Leipzig: Hirzel.
8Schizoaffective mixed statesAndreas Marneros, Stephan Röttig, Andrea Wenzel, Raffaela Blöinkand Peter BriegerMartin-Luther University Halle-Wittenberg, Halle, GermanyIntroductionHardly any studies on schizoaffective mixed states exists. However, an exception isthe Cologne study carried out by Marneros et al. in the 1980s and 1990s (Marneroset al., 1991). The rarity of research on schizoaffective mixed states is, on the onehand, a paradox, but on the other hand, an understandable phenomenon. Why aparadox? There are two reasons: first, while schizoaffective disorders are wellestablished as diagnostic categories in both Tenth Revision of the InternationalClassifi cati on of Diseases (ICD-10: World Health Organization, 1991) and Di ag no st icand Statistical Manual of Mental Disorders (DSM-IV: American PsychiatricAssociation, 1994), it has also been determined that schizoaffective disordershave to be divided according to their mood component into unipolar and bipolartypes, a fact that implicates the occurrence of schizoaffective mixed states (AmericanPsychiatric Association, 1994; Marneros et al., 19 89a –c; 199 0a , ; b 1991; Marnerosand Angst, 2000). Second, both diagnostic systems, ICD-10 and DSM-IV, define aschizoaffective mixed episode, as shown in Tables 8.1 and 8.2. Therefore,itistobe expected that clinicians and researchers applying either ICD-10 or DSM-IVcriteria diagnose schizoaffective mixed episode. But neither clinical nor practicalexperience, as well as a study of the literature, supports such an assumption.Then, why do these obvious deficits seem understandable? Mainly due to tworeasons: first, the definition of schizoaffective disorders is – in spite of their longhistory and clinical reality – still diffuse and uncertain. Second, the clinical andpsychopathological picture of schizoaffective mixed states is difficult for nonspecializedphysicians to detect.In such cases, schizophrenic, manic, and depressive symptoms form a ratherunclear and diffuse conglomerate – sometimes dominated by schizophrenicsymptoms, sometimes dominated by affective symptoms, each in a varying way.Sometimes the depressive symptomatology is very strong, hiding manic elements,# Cambridge University Press, 2005.
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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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44 A. Marneros and F. K. GoodwinPri
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46 G. Perugi and H. S. AkiskalTable
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50 G. Perugi and H. S. AkiskalDepre
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52 G. Perugi and H. S. Akiskalwith
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54 G. Perugi and H. S. Akiskal3020.
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59 Longitudinal perspective of mixe
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3Rapid-cycling bipolar disorder1 2O
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63 Rapid-cycling bipolar disorderPs
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65 Rapid-cycling bipolar disorderOn
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67 Rapid-cycling bipolar disorderBr
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69 Rapid-cycling bipolar disorderin
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71 Rapid-cycling bipolar disorderLa
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73 Rapid-cycling bipolar disorderre
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83 Rapid-cycling bipolar disorderRE
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87 Rapid-cycling bipolar disorderde
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89 Bipolar I and bipolar II: a dich
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101 Bipolar I and bipolar II: a dic
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5Recurrent brief depression as an i
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111 Recurrent brief depressionRecur
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113 Recurrent brief depressionbeen
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115 Recurrent brief depressioncorre
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117 Recurrent brief depressionThere
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Chronic 4.8 18.2 9.1 10 NCRapid-cyc
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121 Recurrent brief depressionTable
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123 Recurrent brief depressionPreva
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125 Recurrent brief depressionWe fo
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127 Recurrent brief depressionREFER
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129 Recurrent brief depressionMarne
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6Atypical depression and its relati
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133 Atypical depression and bipolar
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Page 221 and 222: 9Acute and transient psychotic diso
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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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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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375 Investigational strategiesWhat
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377 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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