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

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.