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

32 A. Marneros and F. K. GoodwinBipolar patients(n = 277)Bipolar schizoaffectivepatients(n = 23)8.3%36.1%Bipolar affectivepatients(n = 100)55.6%Bipolar unclassifiablepatients(n = 154)Fig. 1.13Tenth Revision of the International Classification of Diseases (ICD-10) longitudinalclassification of bipolar patients in the Halle Bipolarity Longitudinal Study (HABILOS).type (Marneros et al., 1986–2004): the concurrent type is characterized by thecoincidence of schizophrenic and affective episodes, while the sequential type ischaracterized by the longitudinal change from schizophrenic to affective episodesand vice versa (Marneros et al., 1986, 1988c, 1989a, 1991b, 2000; Marneros andAngst, 2000).How essential it is to make a longitudinal diagnosis is illustrated by theHABILOS, in which the investigators tried to allocate disorders with manicsymptomatology into pure mood disorders or schizoaffective disorders, accordingto DSM-IV, ICD-10, and to an empirical definition by the Marneros group(as defined above). Applying the ICD-10 definition, the findings illustrated inFigure 1.13 were produced. As shown, only 8.3% of the 277 patients could beallocated longitudinally as schizoaffective bipolar and 36.1% as affective bipolar,while the majority of patients (55.6%) could not be allocated longitudinally becauseof the occurrence of different types of episodes (schizophrenic, schizoaffective,affective) at different times.However, if we use the empirical definition with its cross-sectional and sequentialaspect, all patients can be allocated: 36.1%, as in the ICD-10 categorization,could be allocated as bipolar mood disorder, and 63.9% could be allocated asschizoaffective disorder (Fig. 1.14).Recent research has confirmed earlier assumptions that schizoaffective disordersoccupy a position between affective and schizophrenic disorders as regardsrelevant sociodemographic and premorbid features, as well as patterns of course,outcome, treatment response, and prophylaxis (Maj, 1985; Maj and Perris, 1985;