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

196 A. Marneros et al.ManicDepressiveMixed affective62 (2.9%)486 (22.9%)613(28.9%)Schizomanic312 (14.7%)SchizodepressiveMixed schizoaffective56 (2.6%)133 (6.3%)SchizophrenicOthers251 (11.8%)206 (9.7%)Fig. 8.3 Types of episode (n ¼ 2119).0 100 200 300 400 500 600 700the ICD-10 definition. Out of the 2119 episodes evaluated, the most frequent typeof episode was the depressive one (n ¼ 613; 29% of all episodes). Mixed episodeswere found to be the rarest type of episodes: there were only 118 affective andschizoaffective mixed episodes (ICD-10) (6%) and the frequency of mixed affectiveepisodes (n ¼ 62; 3%) was almost identical to that of mixed schizoaffectiveepisodes (n ¼ 56; 3%; Fig. 8.3).These findings of HABILOS confirm the results from other studies that the mostfrequent type of episodes in bipolar disorders is the depressive type (Marneros andBrieger, 2002 ; Marneros et al., 1990a, b; 1991; see chapter 2 ).Interestingly, although the inclusion criterion for the study population was thepresence of ‘‘bipolar episodes’’ (i.e., manic, schizomanic and mixed), 251 episodes(12%) fulfilled the ICD-10 criteria of a schizophrenic episode, in addition to thedepressive and schizodepressive episodes. This is compatible with findings showinga syndromal instability in the course of bipolar disorder (Marneros et al.,1990b; 1995; Marneros and Pillmann, 2004). This finding repeatedly demonstratesthat ICD and DSM criteria of disorders not involving syndrome changes duringlongitudinal course are not sufficient to define ‘‘diseases.’’ According to the longitudinalcriteria proposed by Marneros et al. (1986, 1991), mood disorders with‘‘syndrome shift’’ into schizophrenic syndromes and vice versa fulfill the criteria ofthe ‘‘sequential type’’ of schizoaffective disorders.Duration of episodesBased on methodological considerations, we decided to evaluate, as a first step, thelength of episodes according to length of inpatient treatment. Obviously, this isnot the real duration of an episode, but it certainly serves as an indicator for thereal duration of an episode. Mixed episodes are, according to classical but also new