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

216 A. Marneros et al.Table 9.8 Diagnostic criteria for bouffée délirante (Pull et al., 1983)1. Age of onset: approximately 20–40 years2. Onset: acute, without any prior psychiatric history (other than identical episodes)3. No chronicity: active phases fade away completely in several weeks or months, possiblyrecurring under the same form: the patient remains devoid of all abnormalities in theinterval4. Characteristic symptoms (all of the following):* Delusions and/or hallucinations of any type* Depersonalization/derealization and/or confusion* Depression and/or elation* Symptoms vary from day to day even from hour to hour5. Not due to any organic mental disorder, alcoholism, or drug abusepatients found with the acute polymorphic psychotic disorders of the ICD-10 andcycloid psychosis when applying the criteria used by Perris (Pillmann et al., 2003b;Marneros and Pillmann, 2004). They can be assumed to be a part of the acutepolymorphic psychotic disorders, as defined by the WHO (Pillmann et al., 2003b;Marneros and Pillmann, 2004).Other predecessorsAnother synonym for ATPD is that of ‘‘atypical psychoses,’’ which is mainly aJapanese concept (Perris, 1986). The creator of the concept of atypical psychoses inJapan was Hisatoshi Mitsuda, who presented this topic for the first time in 1941.Atypical psychoses are characterized by an acute onset of illness, a favorableprognosis, and a tendency toward relapse. They show strong similarities with theconcept of cycloid psychoses. In contrast to Kleist and especially to Leonhard,Mitsuda had doubts regarding the full remission of all cases with atypical psychoses(Mitsuda, 1965; Kimura et al., 1984; overview in Fukuda, 1990). Accordingto family studies by Mitsuda and Fukuda (1974), atypical psychoses have to beregarded as separate from both schizophrenia and depressive psychoses and fromthe epileptic psychoses, although some overlaps may occur. It has been assumedthat atypical psychoses, as defined by the Japanese psychiatrists, have somesimilarities to epileptic psychoses. This assumption could not be supported inthe HASBAP (Röttig, 2001; Marneros and Pillmann, 2004).Reactive or psychogenic psychoses are also among the synonyms given by theWHO for ATPD. So-called reactive/psychogenic psychoses have a very strongtradition, mainly in Scandinavia (Strömgren, 1986). The basic concept was developedby August Wimmer (1916) in parallel with Karl Jaspers (1913). According to