Bipolar affective disorder has been of particular interest to medical research for thousands of years. The rapid and, for the uninitiated, incomprehensible change from manic to depressive moods and vice verse requires an explanation. At the time of Hippocrates the cause was thought to be a dysregulation of the four body fluids, blood, yellow (choler) and black (melancholy) bile. and phlegm. As early as the second century AD. Galen identified the brain as the site of
the illness.
In the first century AD. the Greek physician Aretaeus of Cappadocia first described mania as the phenomenological opposite to depression. After his death he was forgotten until 1554 when his two manuscripts "On the Causes and Symptoms of Acute and Chronic Diseases" and "On the Treatment of Acute and Chronic Diseases" were rediscovered. In these works he described mania as an excessive increase of melancholy, he thus established a unified concept of disease.
This "modern" concept was taken up by French scientists before the turn of the 19th century; jean-Pierre Falret described "la folie circulaire" to characterize the changes between depression, manic excitation, and a healthy interval. At about the same time Jules Bail larger formulated the concept of "folie a double forme" as different manifestation forms of the same disorder in which mania and depression can occur alternately without the necessity for a symptom-free interval in between,
On the basis of the unified concept of psychiatry proposed by Kraepelin at the beginning of the 20th century, the then used term manic-depressive psychosis included many affective illnesses that are now recognized in modern classification systems as individual clinical entities. At that time Kraepelin still assumed a uniform "manic-depressive insanity" in which. however, he did discuss the important condition, classified today as "mixed states", i.e., the simultaneous occurrence of manic and depressive symptoms.
According to Kraepelin. manias and depressions were different presentations of one and the same disorder. Thus, he did not differentiate between unipolar and bipolar affective disorders. The later work of Leonhard led to the formulation ofthe distinction between bipolar and unipolar affective illness that is still valid today. Among the manic-depressive diseases. Leonhard placed special emphasis on the "cycloid psychoses" that would today rather be classified by modern reductive systems as mixed states. In contrast to the classification system used mainly in the USA — the "Diagnostic and Statistical Manual of Mental Disorders" (USM IV. Sass et.al.1966) to which the classification criteria used in this book refer — the currently valid version of the "international Classification oi` Mental and Behavioural Disorders" (ICD-10) finally also differentiates monopolar mania more clearly from bipolar disorder. However. studies on disease course have shown that monopolar mania practically does riot exist. As a result of more meticulous course observations and the increasing knowledge about the causes of the illness. bipolar disorder is increasingly being subject to a more differentiated consideration. Differences in the prognosis and treatment of the entire spectrum of bipolar disorder are now being seen more exactly for the first time and their special features will certainly be more emphasized in future classification systems.
The Frequency of Bipolar Disorder
The entire spectrum of bipolar disorder according to DSM IV is characterized hy the occurrence of at least one manic or hypomanic mood state. According to investigations by Angst( 1980) the numerical distribution of recurrent affective disorder amounts to about two-thirds as monopolar depression and about one-third as bipolar disorder.
The data on prevalence also naturally change with changes and expansions of the classification criteria. lt is certain that bipolar disorder is not rare. Bipolar I disorder exhibits a Iife—time prevalence rale of between LU and 1.5% in different countries. ie., at least one in one hundred people will suffer from the illness during his/her life time. The relatively small range of the prevalence rate for bipolar disorder compared with that of unipolar depression (Between 1.5% in Taiwan and 19% in Beirut, Lebanon) is worthy of note.
The study by Angst (1980) in Zurich came to about the same results. In a later investigation the prevalence rate was found to be appreciably higher (12%) (Angst 2001]. Thorough examinations and interviews revealed that many patients initially classified as unipolar depressives had had at least one short hypomanic phase and accordingly had to be characterized as bipolar ll patients. In addition, investigations on the course of patients initially classified as unipolar depressive showed that over a period of 15 years at least one manic or hypomanic phase has occurred in 46% (Goldberg et al. 2001). Since a large proportion of the bipolar patients at first experience depressive phases, they were initially classified as "false unipolar”. Thus. it can be assumed that the number of patients with bipolar disorder will rather increase in the future as a consequence of better systematic study designs.
Age and Gender Distribution
Bipolar disorder mostly occurs appreciably earlier than unipolar depression. on average about 6 years earlier. 75 % of the patients experience their first episode of the illness prior to the age of 25 years as compared to only 55% for unipolar depression. Among bipolar illnesses, however, there is no difference between bipolar I and bipolar ll. In contrast to unipolar depression. which affects women twice as often as men. the gender distribution of bipolar disorder is about equal. Rapid cycling. however. is an exception... jump read : Bipolar Affective Disorder : Etiology and Treatment
the differences symptoms of bipolar disorder in child and teenagers. Not only them that can be the victim but also pregnant women , they also potential target turn into bipolar pregnant women.
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