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

202 A. Marneros et al.In the state of Saxony-Anhalt (Germany), where this study was carried out, alldisability payments were granted at a mean age of 50.2 years in 1999. According tothe official statistics, the age when disability payments were granted for affective,schizophrenic, and other psychotic disorders, was 7.2 years (males) and 14.2 years(females) earlier than the mean age of 50.2 years. Therefore, schizoaffectivepatients and affective patients having mixed episodes were younger when theirdisability payments were granted than the controls (Fig. 8.9).ConclusionsIn spite of existing definitions and criteria for mixed schizoaffective episodes inboth ICD-10 and DSM-IV, very little work on the topic has been carried out. Themain reason is the uncertainty of how to define schizoaffective disorders and astill-ongoing evolution of their concepts. Perhaps another difficulty is the exactestimation of a very complicated symptomatology with schizophrenic, depressive,and manic components during a schizoaffective mixed episode. Nevertheless, thefindings, both from the Cologne study and from the HABILOS, show that at a rateof more than 30%, the frequency of schizoaffective mixed episodes is high andequivalent to that in pure affective disorders.Schizophrenia spectrumBipolar course(bipolar spectrum)Unipolar course(depressive spectrum)Adjustable homeostasis of affectivityFig. 8.10The affective continuum.