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

31 Beyond major depression and euphoric maniaManicSchizomanicMixed schizoaffectiveDepressive Schizodepressive SchizophrenicOthersFig. 1.12Longitudinal course of patients with mixed schizo-manic-depressive episodes in the HalleBipolarity Longitudinal Study (HABILOS).with the definition of ICD-10, which yields three types of schizoaffective episodes:schizodepressive, schizomanic, and mixed.The longitudinal definition of the schizoaffective disorder should consider thesequential occurrence of mood and schizophrenic episodes during the course. Thelongitudinal research demonstrates that the course of schizoaffective disorders canbe very unstable because schizoaffective episodes, pure mood episodes, and pureschizophrenic episodes can each occur at different points in the patient’s longitudinalcourse (Fig. 1.12). What are such disorders when viewed longitudinally?Are they to be considered mood disorders because of the pure mood episodes, orschizophrenic disorders because of some pure schizophrenic episodes, or schizoaffectivedisorders because of some schizoaffective episodes? Relevant to thisquestion is the finding that there are no differences between patients who haveonly had schizoaffective episodes, and those in whom schizoaffective episodesoccur along with pure mood and schizophrenic episodes. Thus, there are nodifferences between the ‘‘concurrent’’ and the ‘‘sequential’’ type of schizoaffectivedisorder (Marneros et al., 1986, 1991a, b). Patients who change from pure moodepisodes to pure schizophrenic episodes and vice versa do not differ from patientshaving schizoaffective episodes. In this sense, Marneros et al. suggest a longitudinaldefinition of schizoaffective disorders, including a concurrent and a sequential