Diagnosis and course of affective psychoses: Was Kraepelin right?
Kraepelin's basic attitude to the classification of psychoses was data-oriented and flexible. In his latter years he was close to revising his own celebrated dichotomy between manic-depressive insanity and dementia praecox in order to take account of a large group of intermediate psychoses, which today are called schizo-affective. His concept of a continuum from healthy to ill has stood the test of time and corresponds to modern epidemiological findings. Kraepelin's unitarian concept of manic-depressive insanity did not survive. It was differentiated and broken down into several subgroups, and a proportional diagnostic spectrum with a continuum from mania via bipolar disorders to depression has recently even been proposed. Bipolar disorders would in that case be comorbid disorders of mania plus depression. In contrast to Kraepelin's unitarian view the long-term prognosis of subgroups of mood disorders varies considerably. Overall it is nevertheless astonishing how much of Kraepelin's legacy has survived.
Available from: Marta Serati
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ABSTRACT: The presence of comorbidity in major psychoses (e.g., schizophrenia and psychotic subtypes of bipolar disorder and major depressive
disorder) seems to be the rule rather than the exception in both DSM-IV and ICD-10. Examining comorbidity in major psychoses,
however, requires an investigation into the different levels of comorbidity (either full-blown and subsyndromal) which should
be analyzed in both psychopathological and medical fields. On one hand, the high prevalence of psychiatric comorbidity in
major psychoses may be the result of the current nosographic systems. On the other hand, it may stem from a common neurobiological
substrate. In fact, comorbid psychopathological conditions may share a biological vulnerability, given that dysfunction in
specific brain areas may be responsible for different symptoms and syndromes. The high rates of comorbidity in major psychoses
require targeted pharmacological treatments in order to effectively act on both the primary diagnosis and comorbid conditions.
Nevertheless, few controlled trials in comorbid major psychoses had been carried out and treatment recommendations in this
field have mostly an empirical basis. The aim of the present article is to provide a comprehensive and updated overview in
relation to epidemiological and clinical issues of comorbidity in major psychoses.
KeywordsComorbidity–Major psychoses (MPs)–Schizophrenia (SK)–Bipolar disorder (BD)–Psychotic major depressive disorder (pMDD)
European Archives of Psychiatry and Clinical Neuroscience 10/2011; 261(7):489-508. DOI:10.1007/s00406-011-0196-4 · 3.53 Impact Factor
Available from: Heather Hower
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ABSTRACT: The authors sought to assess the longitudinal course of youths with bipolar spectrum disorders over a 4-year period.
At total of 413 youths (ages 7-17 years) with bipolar I disorder (N=244), bipolar II disorder (N=28), and bipolar disorder not otherwise specified (N=141) were enrolled in the study. Symptoms were ascertained retrospectively on average every 9.4 months for 4 years using the Longitudinal Interval Follow-Up Evaluation. Rates and time to recovery and recurrence and week-by-week symptomatic status were analyzed.
Approximately 2.5 years after onset of their index episode, 81.5% of the participants had fully recovered, but 1.5 years later 62.5% had a syndromal recurrence, particularly depression. One-third of the participants had one syndromal recurrence, and 30% had two or more. The polarity of the index episode predicted that of subsequent episodes. Participants were symptomatic during 60% of the follow-up period, particularly with subsyndromal symptoms of depression and mixed polarity, with numerous changes in mood polarity. Manic symptomatology, especially syndromal, was less frequent, and bipolar II was mainly manifested by depressive symptoms. Overall, 40% of the participants had syndromal or subsyndromal symptoms during 75% of the follow-up period, and 16% of the participants experienced psychotic symptoms during 17% the follow-up period. Twenty-five percent of youths with bipolar II converted to bipolar I, and 38% of those with bipolar disorder not otherwise specified converted to bipolar I or II. Early onset, diagnosis of bipolar disorder not otherwise specified, long illness duration, low socioeconomic status, and family history of mood disorders were associated with poorer outcomes.
Bipolar spectrum disorders in youths are characterized by episodic illness with subsyndromal and, less frequently, syndromal episodes with mainly depressive and mixed symptoms and rapid mood changes.
American Journal of Psychiatry 06/2009; 166(7):795-804. DOI:10.1176/appi.ajp.2009.08101569 · 12.30 Impact Factor
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ABSTRACT: Bipolar disorder is a severe recurrent psychiatric illness that often manifests in adolescence, a time of marked neurobiological change. The current model is one of multiple susceptibility genes interacting with other risk factors leading to alterations in the normal maturational trajectory of the CNS. Longitudinal studies of children of affected parents has enabled mapping of the early natural history of bipolar disorder. Convergent evidence from longitudinal high-risk studies suggest that bipolar disorder evolves in a series of clinical stages from nonspecific childhood disorders to depressive disorders in early adolescence and bipolar spectrum disorders in later adolescence and adulthood. At present, genetic studies and research into specific biological markers in bipolar patients and their family members are underway. Advances in understanding the neurobiological underpinnings of bipolar disorder will require addressing etiological heterogeneity of bipolar disorder and refining the phenotypic definition. In the latter case, the staging model may be a helpful organizing framework.
Future Neurology 03/2010; 5(2):317-323. DOI:10.2217/fnl.10.3
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