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

14 A. Marneros and F. K. GoodwinFig. 1.7The modus of manifestation of mixed states of manic-depressive insanity (according toKraepelin, 1913).additionally, the symptom flight of ideas changes to inhibition of thought, only thehyperactivity remains as a manic symptom and, thus, ‘‘excited’’ or ‘‘agitateddepression’’ can arise. Mania with thought poverty occurs if poverty of thoughtis associated with the manic symptom euphoria and perhaps also hyperactivity.The basis of the next three types of mixed states – according to Kraepelin – isthe fundamental symptomatology of depression, namely ‘‘inhibition of thought,’’‘‘depressive mood,’’ and ‘‘weakness of volition.’’ ‘‘Manic stupor’’ (which forWeygandt is the most important type of mixed state and for Kraepelin the mostconvincing) arises when depressive mood is replaced by ‘‘euphoria,’’ but depressivethoughts and lack of will or abulia persist. ‘‘Depression with flight of ideas’’ comesinto being when the poverty of thoughts is replaced by flight of ideas, while the twoother basic symptoms of depression (depressive mood and abulia) continue. If, inaddition to flight of ideas, depressive mood changes to euphoria, ‘‘inhibited mania’’arises. Kraepelin separated inhibited mania from manic stupor because flight ofideas is absent in manic stupor, but present in inhibited mania.