Concept Of Manic-depressive Illness Research Articles

The genealogy of the clinical syndrome of mania: signs and symptoms described in psychiatric texts from 1880 to 1900.

In 1800, mania was conceptualized as an agitated psychotic state. By 1900, it closely resembled its modern form. This paper reviews the descriptions of mania in Western psychiatry from 1880 to 1900, when Kraepelin was training and developing his concept of manic-depressive illness. Psychiatric textbooks published 1900-1960 described 22 characteristic manic symptoms/signs the presence of which were recorded in 25 psychiatric textbooks and three other key documents published 1880-1900. Descriptions of mania in these nineteenth century textbooks closely resembled those in the twentieth century, recording a mean (s.d.) of 15.9 (2.3) and 17.0 (2.3) of the characteristic symptoms, respectively (p = 0.12). The frequency with which individual symptoms were reported was substantially correlated in these two periods (r = +0.64). Mendel's 1881 monograph, Kraepelin's first description of mania in 1883 and the entry for mania in Tuke's Dictionary of Psychological Medicine (1892) described a mean (s.d.) of 19 (1.7) of these characteristic symptoms. These descriptions of mania often contained phenomenologically rich descriptions of euphoria, hyperactivity, grandiosity, flight of ideas, and poor judgment. They also emphasized several features not in DSM criteria including changes in character, moral standards and physical appearance, and increased sense of humor and sexual drive. Fifteen authors described key symptoms/signs of mania most reporting elevated mood, motoric hyperactivity and accelerated mental processes. By 1880, the syndrome of mania had been largely stabilized in its modern form. In the formation of his concept of manic-depressive illness, Kraepelin utilized the syndrome of mania as described in the psychiatric community in which he was trained.

Utility without validity is useless.

Utility without validity is useless.

The Bipolar Spectrum

Byline: M. Reddy it to Broaden it to Shrink it to Broaden it.... ! is the beginning and a part of Mania…. The development of Mania is really a worsening of the disease (Melancholia) rather than change into another disease. (Aretaeus of Cappadocia, 100 AD). Mania is Primary, with Depression being the consequence of preceding Mania, which means the Recurrent Unipolar subgroup of MDI does not really exist since all depressive presentations are preceded by a manic presentation. (Koukopoulos, 2006). That Happiness and Sadness, the two normal and very common emotions of every human being, constitute the core clinical features of a disease, Depressive Illness (MDI), remains a fascinating, though disturbing, fact. The magnification of joy and worry, two poles of the normal emotional spectrum, reaches such gigantic proportion necessitating treatment. The clinical presentation varying between the two poles, often alternating, naturally reveals itself as a spectrum disorder of conditions and related temperaments. For Eugene Bleuler a patient was predominantly schizophrenic or predominantly manic-depressive in the spectrum of psychosis. But Emil Kraeplin, father of classification in modern psychiatry, segregated the two major psychotic illnesses into Manic-depressive insanity and Dementia praecox. By 1913, Kraeplin brought virtually all of the major clinical forms, which had *Episodic or Periodic course *Benign prognosis *Family history of MDI, under the diagnosis of -Depressive illness (MDI) in which he included Bipolar Disorders (BD) and Recurrent Depressive Disorders. The Bipolar Spectrum concept can be approached from two different ways: *Manic - Depressive Spectrum: Continuum between Bipolar and Unipolar *Bipolar Spectrum: Restricted to BD with continuum between Full blown illness (BD I) to Milder illness to Temperament traits (Cyclothymia ……). Understanding the concept of Bipolar/Manic Depressive Spectrum demands a brief journey into the history dating back to the last quarter of 19th century. SHRINK IT - 1875-1925 [Figure 1]{Figure 1} The Northwest Wales asylum, opened in 1848, catered to a specific geographic location of the population and had admission of 3172 patients from 1875 to 1924. As depicted in the graph, mania as percentage of all admissions was 60% in 1885 which got Shrunk to around 20% in 1920. In 1885, the diagnosis of mania referred to any state of OVERACTIVE INSANITY. Around 1900, primarily in response to Kraeplin's impact, the use of mania as a diagnosis in North Wales began to fall (limited only to episodic illness with benign course) progressively to about 4% in 1924.[1] BROADEN IT: 2nd quarter of 20th century Manic Depressive insanity….. includes on one hand the whole domain of periodic and circular insanity, on the other hand simple mania, the greater parts of the morbid states termed Melancholia (Emil Kreaplin, 1924). [INLINE:1] The unifying Broadeningconcept of MDI, which brought together all the mood disorders, separating from Dementia Praecox, was based on *Episodic, recurrent course of illness *Benign course and outcome. SHRINK IT (again): 2nd half of 20th Century Move forward to the 3rd quarter and the first half of the 4th quarter of 20th century. The Kreaplinian concept of MDI was considered too inclusive and in 1957 Karl Leonhard proposed the concept, propagated later by the works of Angst, 2002,[2] and Perris, of dividing the MDI into two sub groups: Bipolar and Unipolar, the only difference being presence/absence of mania. The Broad MDI concept was shrunk again by separating BD group away from the unipolar group. The term bipolar was introduced in DSM III in 1980 and in ICD 10 in 1992; since then the unipolar and BD are categorized as two separate diagnostic entities in the classificatory system. …

The bipolar spectrum: origins, validation and critique

The roots of the bipolar spectrum go back to ancient Greek medicine linking temperaments to melancholia, fear to melancholia, and melancholia to mania. The subject was taken up by French alienists in the mid nineteenth century and then given international status by German psychiatrists. DSM-II had a broad concept of manic-depressive illness. DSM-III (and ICD-10) introduced the broad concept of (major) depression, which undermined the continuum concept between depressive, anxiety, and bipolar disorders. Now that comorbidity is fashionable in both clinical and epidemiological studies, and subthreshold psychiatry is being taken seriously, a great deal has been published internationally to convincingly argue for the necessity of returning to the concept of a dimensional extension from bipolar temperaments through recurrent depression, “soft bipolar spectrum”, all the way to the “hard spectrum” and psychotic edge of the spectrum. Despite opinions to the contrary, extensive epidemiologic, course, clinical, and familial-genetic evidence supports the concept of a broad spectrum of affective illness. There may even be some intersection of the affective and schizophrenic spectra. This perspective is also compatible with distinct categorical subtypes within the broad spectrum, because prognostic and therapeutic implications are relevant for clinical practice involving distinct subtypes. The main critiques come from those who live in the “unipolar” world, and the fields of addictive and “borderline” psychiatry with accusations of “nosological imperialism” on the part of those who subscribe to the broad bipolar view. Finally, treatments have been developed largely for the classical, well-defined hard spectrum conditions. Preventive psychiatry, including that of suicide, is an important driving force to address these therapeutic challenges. from International Society on Brain and Behaviour: 3rd International Congress on Brain and Behaviour Thessaloniki, Greece. 28 November – 2 December 2007

Affective equivalents.

Since its first formulation, the concept of manic-depressive illness has been subject to successive modification and, on the whole, to progressive enlargement. It was Kraepelin, following on the attempts of Baillarger, Falret and Magnan, who grouped together all the various nosographic forms distinguished by isolated depressive or manic crises, periodic or alternating (and even the form designated as involutional melancholia), including them all under the sole class name of manic-depressive psychosis. The morbid entity thus defined was regarded as distinguished by the periodicity of the crises, each with a tendency towards social remission. Aetiologically the causation was seen as preponderantly hereditary.