Abstract
Mood is the changing expression of emotion and can be described as a spectrum. The outermost ends of this spectrum highlight two states, the lowest low, melancholia, and the highest high, mania. These mood extremes have been documented repeatedly in human history, being first systematically described by Hippocrates. Nineteenth century contemporaries Falret and Baillarger described two forms of an extreme mood disorder, with the validity and accuracy of both debated. Regardless, the concept of a cycling mood disease was accepted before the end of the 19th century. Kraepelin then described “manic depressive insanity” and presented his description of a full spectrum of mood dysfunction which could be exhibited through single episodes of mania or depression or a complement of many episodes of each. It was this concept which was incorporated into the first DSM and carried out until DSM-III, in which the description of episodic mood dysfunction was used to build a diagnosis of bipolar disorder. Criticism of this approach is explored through discussion of the bipolar spectrum concept and some recent examinations of the clinical validity of these DSM diagnoses are presented. The concept of bipolar disorder in children is also explored.
Highlights
The overarching structure in which the changing expression of emotions is shaped is known as mood, and this long-term mood fluctuates over time [1]
The spectrum of bipolar illness encompassed broader manifestations of bipolar illness: Bipolar I described the full-blown manic episode which occurs in the context of more regular depressive episodes, Bipolar I 1{2 described protracted hypomania in the context of depression, Bipolar II described depression with definite hypomanic episodes, Bipolar II 1{2 described cyclothymic depression with shorter hypomanic episodes, Bipolar III described hypomania induced by antidepressant treatment or the cessation of it, Bipolar III 1{2 described mania which can be induced by substance abuse, and Bipolar IV would be a lifelong hyperthymic temperament with clinical depression [24]
There was no significant difference in the rate of treatment-emergent affective switching between groups, rather that switching was more likely if the subjects had been diagnosed with Bipolar I (BP I) or presented with concomitant manic symptoms at baseline [34], again highlighting this very important distinction between those which display mania at any point compared to those who exhibit true unipolar depression
Summary
The overarching structure in which the changing expression of emotions is shaped is known as mood, and this long-term mood fluctuates over time [1]. The outermost ends of this spectrum highlight two states which are linked to mental illness and are experienced in bipolar disorder; the lowest low, melancholia, and the highest high, mania. These mood states can exist at the same time and overlap with the expression of emotions of conflicting affective states such as irritability with elation [1,2]. How these two states relate to each other and how mood shifts between states is explored in this review detailing the history of the bipolar disorder diagnosis
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