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

192 A. Marneros et al.(1) schizoaffective disorders, at the present manic(2) schizoaffective disorders, at the present depressive(3) mixed schizoaffective disorder(4) other schizoaffective disorders(5) schizoaffective disorders not otherwise specifiedThe evolution of the concept and definitions of schizoaffective disorders continues.Many aspects remain to be clarified, and many questions still requireanswers. Most diagnostic systems only recognized the concurrent form of schizoaffectivedisorders, not the sequential one. But operational research showed nodifferences in any investigated dimension between concurrent and sequentialschizoaffective disorders (Marneros et al., 1986; 1988a–c; 1991).As we previously pointed out (Marneros, 1999), the ongoing evolution of conceptsand definitions of schizoaffective disorder lead to enduring uncertainty. The question:What are the schizoaffective disorders? remains unanswered, which is also a reason whyonlymeagerresearchresultsexistinthecomplicatedfieldofschizoaffectivemixedstates.Current research in schizoaffective mixed statesSchizoaffective mixed states in the Cologne studyAs mentioned above, for the most part, systematic research on schizoaffectivemixed states has not been published. An exception is research performed as a partof the Cologne study (1986–1991). The Cologne study, which is a longitudinalstudy comparing schizophrenic, affective, and schizoaffective disorders, has beenpublished in several presentations and in a monograph, which also includes anextensive English summary (Marneros et al., 1991). A total of 402 patients werefollowed-up for an average of 25 years after the onset of their illness. The diagnoses,obtained longitudinally, were as follows: schizophrenic disorders (n ¼ 148), schizoaffectivedisorders (n ¼ 101), affective (mood) disorders (n ¼ 106).A distinction was made between ‘‘episode’’ (which is only a cross-sectionaldiagnosis) and ‘‘illness’’ or ‘‘disorder’’ (which are longitudinal diagnoses). The‘‘episodes’’ (cross-sectionally defined) were classified according to slightly modifiedDSM criteria into schizophrenic, affective (depressive, manic, manic-depressivemixed), schizoaffective (schizodepressive, schizomanic, schizomanic-depressivemixed) and non-characteristic episodes.The diagnoses of an ‘‘illness’’ or ‘‘disorder’’ were made only longitudinally andtook into account all types of episodes occurring during the whole course. Thefinal diagnoses were longitudinally defined as follows:* schizophrenic disorders: only schizophrenic episodes during the whole course* affective (mood) disorders: only depressive, manic, or manic-depressive mixedepisodes during the whole course