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

218 A. Marneros et al.Summarizing the findings of the HASBAP, it can be said that ATPD, as definedby the ICD-10, are disorders:* mainly concerning females* with possible onset in all ages of adult life, but usually between the 30th and 50thyears of life* having an acute or even abrupt onset* with an onset only rarely dependent on acute severe stress* with a very short psychotic period* with a very good response to antipsychotic drugs* with a usually favorable outcome, in spite of the fact that they are usuallyrecurrentPeople suffering from ATPD can be described as follows: a majority of patientswith ATPD have an average education, occupational status, and level of functioning,with no significant difference from the mentally healthy population. Theyhave an average level of social interaction and activities, as well as the same frequencyof stable heterosexual partnerships as mentally healthy people do. But, because of therecurrence of their illness, it is possible in some socioeconomic systems, especially intimes of high unemployment, to be excluded from the labor market. Nevertheless,even in such situations, they do not usually lose their autarky.There are some significant differences between acute and transient psychotic disordersand schizophrenia. Summarizing the findings of the HASBAP, it can be notedthat there are significant differences between ATPD and schizophrenia regarding:* gender distribution* age at onset* premorbid level of functioning and social interactions* onset, development, duration, and phenomenology, as well as structure ofsymptomatology* level of postepisodic functioning and outcome in generalButitseemsthatasubgroupofATPD–the‘‘acute schizophrenia-like psychoses’’ –has a closer relationship to schizophrenia and schizoaffective disorders.According to the findings of the HASBAP, the question of the nosologicalindependence of the ATPD in general, but especially of their core group – thebrief polymorphic psychoses – must be rejected. This is not only due to the manyand relevant overlaps in all the domains investigated with the other two psychoticgroups, and, considering the knowledge available, with the major affective disorders,but mainly because of their syndromatic instability. Even if the group of schizophrenia-likepsychoses is excluded, and, if only the more homogeneous group ofacute polymorphic psychoses is considered, then it is still clear that 60% of patientswith more than one episode have other kinds of episode (especially affective andschizoaffective) than ATPD episodes during the course. The changeability of type of