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

232 A. Marneros et al.Notes to Table 9.15 (cont.)c Differences overall significant in ANOVA (P = 0.035); pairwise comparisons given aresignificant (P< 0.05) in Scheffé test.d Differences overall significant in ANOVA (P = 0.012); pairwise comparisons given aresignificant (P < 0.05) in Scheffé test.NEO-FFI, NEO Five-Factor Inventory; ANOVA, analysis of variance.ConclusionsAt the beginning of this chapter, we reported the opinion of Karl Kleist, who wasthe main creator of cycloid disorders and also one of the most important antagonistsof Emil Kraepelin. He wrote that many cases described by Emil Kraepelin asmixed states could be better described as ‘‘cycloid psychoses.’’Cycloid psychoses, according to Kleist, are bipolar disorders, but differ frommanic-depressive illness. After Kleist’s publications, the concept of cycloid disorderscreated interest in psychiatrists outside Germany, such as Carlo Perris inSweden (Perris, 1986), Frank Fish (1964), Ian F. Brockington (Brockington et al.,1982a, b) in the UK, and Mario Maj in Italy (1990) (see also Marneros andPillmann, 2004). Therefore, there is an international, but limited, acceptance ofcycloid psychoses. Nevertheless, the WHO integrated this concept in the categoryof ATPD (F23) of ICD-10. In particular, one subgroup of ATPD, called ‘‘polymorphicpsychotic disorder,’’ has considerable concordance with the concept ofcycloid disorders (Pillmann et al., 2001). In spite of some similarities betweenATPD and ‘‘classical’’ bipolar disorders, there are some differences. Patients withATPD are more frequently females, at their onset they have a better prognosis, andthey more frequently have an asthenic polymorphic personality than bipolarpatients. The comparison between ATPD and schizoaffective mixed states showedthat the prognosis of ATPD is much better than in schizoaffective mixed states,and that females are significantly more frequently represented in the group ofATPD. However, in spite of some similarities in phenomenology, there are alsodifferences between the two groups.Our investigations showed that ATPD, especially the core group – the polymorphicpsychotic disorders and therefore also the so-called cycloid disorders – arenot identical with manic-depressive illness. This is evident because the occurrence ofthe full syndrome of mania or the full syndrome of major depression are exclusioncriteria. We have also shown further differences in other investigations (Marneroset al., 20 00 , 2 00 2, 20 03 ;Pillmann et al ., 2001, 2002a, b, 20 03 ; a Marneros andPillmann, 2004). The longitudinal investigations support an interpretation thatlocates the polymorphic psychotic disorders on a continuum between schizophrenia