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

198 A. Marneros et al.Bipolar affective(n = 100)Mixed25.0%Bipolar schizoaffective(n = 177)Mixed32.2%Fig. 8.5Non-mixed75.0%Non-mixed67.8%Frequency of patients with at least one mixed episode.anticonvulsants, especially valproate, carbamazepine, and lamotrigine. The positiveresponse of mixed states to the above-mentioned mood stabilizer have been repeatedlydocumented (Calabrese et al., 2000; see Chapter 3).Perhapsthisisaneffectof the new mood stabilizers. Additionally, none of the patients in the Colognestudy received atypical neuroleptics because the study was closed before atypicalneuroleptics were introduced, while almost all patients with mixed states of theHABILOS received atypical neuroleptics. The positive response of patients withmixed states to typical neuroleptics is also documented (Tohen, 2000; seechapter 16). Perhaps treatment with atypical neuroleptics or even a combinationof novel neuroleptics with novel mood stabilizers, is another factor contributingto the shortness of episodes. Finally, one should not overemphasize these findings,as statistically the length of duration of treatment was identical for allepisode types. More indepth analysis will be needed.Frequency of patients having mixed episodesFollowing the ‘‘empirical longitudinal diagnosis of schizoaffective disorder’’(Marneros et al., 1986, 1991), we were able to allocate all the HABILOS patientsinto two categories:(1) bipolar affective patients, who had only affective episodes (depressive, manic,mixed) but no schizoaffective or schizophrenic episodes during the entirecourse of their illness(2) bipolar schizoaffective patients, with at least one schizoaffective episode duringthe illness course, or when schizophrenic and affective episodes occuredsequentially (see Chapter 1)Applying this clinical and longitudinal classification, 100 patients were diagnosedas bipolar affective and 177 as bipolar schizoaffective. The high proportion ofschizoaffective courses may reflect the specialization of our hospital in such disorders.As shown in Figure 8.5, 25% of the bipolar affective patients had at least