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

33 Beyond major depression and euphoric maniaBipolar patients(n = 277)36.1%Bipolar affectivepatients(n = 100)Bipolar schizoaffectivepatients(n = 177)63.9%Fig. 1.14Empirical longitudinal classification of bipolar patients in the Halle Bipolarity LongitudinalStudy (HABILOS). Schizoaffective ¼ occurence of schizoaffective episodes or sequentiallyschizophrenic and affective episodes.Angst, 1986, 1989; Marneros et al., 1988a–c, 1989a–c, 1991a, b; Deister et al., 1990;see also various contributions in Marneros 1989; and in Marneros and Tsuang,1986, 1990; as well as Marneros et al., 1995).It seems certain that schizoaffective disorders are not simply a type of schizophrenicdisorder, although in some cases with schizo-dominance, the relationshipto schizophrenia is clear. With respect to the relationship between schizoaffectiveand mood disorders, the similarities are more compelling than the differences(Marneros and Tsuang, 1986, 1990; Marneros et al., 1995; Marneros, 1999).Atypical depressionsThe DSM-IV defines non-melancholic and non-catatonic major depressive episodesor dysthymic disorders as forms of ‘‘atypical depression’’ (full title: ‘‘criteriafor atypical features specifier’’) when they fulfill the criteria shown in Table 1.6.A look in the historical literature shows that the term ‘‘atypical depression’’ hasmany meanings (Angst et al., 2002; Parker et al., 2002). In 1959, West and Dally inLondon identified a group of patients with good response to monoamine oxidaseinhibitors as having atypical depression ‘‘resembling anxiety hysteria with secondarydepression,’’ who had previous phobias and ‘‘hysterical conversions’’ and wereless likely to have clinical features of ‘‘classical endogenous depression.’’ The