Bipolar Disorders by Mario Maj, Hagop S. Akiskal, Juan José López-Ibor Jr.,

By Mario Maj, Hagop S. Akiskal, Juan José López-Ibor Jr., Norman Sartorius

Bipolar ailment is a major psychological disease regarding episodes of significant mania and melancholy and impacts nearly one to 3 percentage of the inhabitants. in response to the nationwide Institute of psychological wellbeing and fitness approximately million contributors within the usa by myself are clinically determined with this sickness.

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Our thesis has been that the depressive pole of bipolarityÐand its varied expressionsÐhave been relatively neglected in both the official diagnostic system and in the research literature. In this section we briefly examine the differential diagnosis of bipolar disorder from its closest three neighbours, which present the greatest challenge in clinical practice. Schizoaffective Disorder Although current molecular genetic data have revealed intriguing links between some forms of schizophrenia and bipolar disorder [214], circa 2001, their clinical differentiation does not seem to pose as much trouble CLASSIFICATION, DIAGNOSIS AND BOUNDARIES 35 as in the past.

Other possible candidates on the edges of bipolarity include seasonal depressions without discernible hypomanic episodes, as well as other recurrent depressions of abrupt onset and offset [71]. There also exist patientsÐ about whom clinicians write [22]Ðwith episodic obsessive-compulsive symptoms, periodic states of irritability, or acute suicidal crises in the absence of clear-cut affective symptoms; still others who experience cyclic neurasthenic or sleep complaints or severe brief recurrent depressions [22].

The characteristics which distinguish the depressive phase of bipolars from unipolars have been the subject of several prospective studies [31, 32]. 10 lists the most useful predictors of bipolar I outcome. The composite profile of such a depressive is that of a young person (< 25 years old), with ``loaded'' affective family historyÐor at least one definite bipolar first-degree kinÐwho is psychomotor retarded, or psychotically depressed; in a woman the depressive psychosis can be purperal. Bipolar II switching is more complex, as it involves temperamental factors (and is to be discussed later in this chapter under the heading of bipolar II disorder).

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