Psychopathology 01/2010; 43(4):248-9. · 1.82 Impact Factor
ABSTRACT: The longitudinal course of bipolar I disorders is often characterized by a polymorphism, which means that different kinds of episodes develop during the illness. This study investigated the characteristics, similarities and differences of the long-term course of bipolar I patients regarding the dominance of various kinds of episodes.
One hundred eighty-two (182) patients with DSM-IV bipolar I disorder were longitudinally investigated (approximately 17 years duration of the illness) with standardized instruments. The dominance of mood, schizo-affective and schizophreniform episodes was estimated by means of a mathematic formula. According to that dominance, the patients were divided into three groups (mood-dominated, schizo-affective-dominated, schizophreniform-dominated), and these groups were compared to each other at various levels.
The long-term course of bipolar I patients is usually polymorphic showing not only mood episodes, but also schizo-affective and schizophreniform episodes. Nevertheless it is mainly mood-dominated. There are significant differences between patients with mood-dominated and patients with schizo-dominated course, especially in regard to age at first treatment, family history, global functioning, frequency of disability and age at retirement due to the mental illness. Patients with schizo-affective-dominated course occupy a position in-between, but showing stronger similarities with mood-dominated patients.
The investigation is not blind; therefore, bias cannot be excluded. Retirement due to the mental illness is strongly connected with specific national features.
The polymorphic long-term course of bipolar disorders and the differences and similarities between mood-dominated, schizo-affective-dominated and schizo-dominated types of course could support the argument that a distinction between the prototypes "mood disorder" and "schizophreniform disorder" is not always possible, but that there is an overlap of affective and schizophreniform spectra and an "antagonistic influence" between them. Clinicians need to consider the polymorphism of the bipolar disorder in order to provide adequate treatment and prophylaxis. Researchers have to consider that the boundaries of diagnostic categories are very elastic and permeable, making a psychotic continuum possible.
Journal of Affective Disorders 05/2008; 107(1-3):117-26. · 3.52 Impact Factor
ABSTRACT: Temperament is an important factor in affective illness. There is some indication that mixed episodes result from an admixture of inverse temperamental factors (e.g. depressive and/or anxious) to a manic syndrome. To test this hypothesis, which has been first formulated by Akiskal [Clin. Neuropharmacol. 15 (Suppl. 1A) (1992) 632-633], we compared the temperament of non-acute bipolar affective patients with and without the history of a previous mixed episode.
Patients who had been hospitalized for a bipolar disorder were re-assessed at least 6 months after their last in-patient treatment. Those who met the criteria for a partially remitted or full affective or psychotic episode at re-assessment were excluded from the study. Data concerning illness history, current psychopathology (SCID-I interview), depression (BDI), mania (Self-Report Manic Inventory) and temperament (TEMPS-A scale) were obtained. Patients with and without a history of previous mixed episodes were compared.
Of 49 eligible former patients, 22 subjects with and 23 subjects without a former mixed episode in bipolar affective disorder fulfilled the inclusion criteria. Subjects suffering from bipolar affective disorder exhibited significantly more depressive and anxious and less hyperthymic temperament, if they had experienced a mixed episode previously. Concerning cyclothymic and irritable temperament, bipolar affective patients with a former mixed episode presented non-significantly higher scores. Patients with a former mixed episode presented with higher depression scores than patients without such a history. No group differences were found concerning current mania scores.
(1). This is a preliminary report from an ongoing study. (2). Temperament had not been assessed premorbidly. (3). Although group comparisons revealed significant differences, these did not seem great enough to fully explain the emergence of a mixed episode.
Our findings support the study's hypothesis that mixed episodes occur more often in subjects with an inverse temperament (e.g. depressive and anxious), although it cannot be ruled out that subsyndromal features of the bipolar illness had an effect on temperament assessment.
Journal of Affective Disorders 02/2003; 73(1-2):99-104. · 3.52 Impact Factor