By Kostas N. Fountoulakis

This booklet examines intimately the diagnostic method of manic depressive (bipolar) disease, with exact connection with the borderline zones with unipolar melancholy and schizoaffective affliction. between different diagnostic concerns thought of are combined episodes (often misdiagnosed via psychiatrists), fast biking, and the confusion with character problems. in the context of prognosis and figuring out of the dynamics of bipolar disease, temperament, personality, and character are all commonly mentioned. Neurocognitive deficit and incapacity are lined, as are parts of evolutionary biology and behaviour. with reference to therapy, the most important concentration is on evidence-based treatment, with regards to the result of randomized managed trialsand meta-analyses; additionally, modern instructions and destiny traits are tested. cautious attention can also be given to the psychosocial remedy strategy and concerns in terms of societal and fiscal expenses and burdens.

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Drug/alcohol abuse 14. Comorbid anxiety and other mental disorders 15. Self-destructive behaviour and suicidality TEAS 1 Euthymia Symptoms Symptoms 2 3 4 5 1 TEAS Acute phase Continuation 2 Maintenance 3 Depression Acute phase Fig. 2 Graphic representation of the alteration of types of mood episodes and the course of bipolar disorder. 1 Response, 2 remission, 3 relapse, 4 recovery, 5 recurrence. TEAS treatment emergent affective switch channelling and top-down bias. On the other hand, one should bear in mind that in these times, physicians were confronting with the most severe group of patients, and their observations were based mainly on chronic institutionalized patients, often distorted by personal issues and philosophical and often religious and political influences.

It is both interesting and important to look at the literature which predates the psychopharmacology era, that is, the nineteenth century and the first half of the twentieth century. 1 List of the multiple clinical aspects of manic–depressive illness Mania 33 1. Manic episodes 2. Depressive episodes 3. Mixed episodes 4. Subthreshold manic symptoms 5. Subthreshold depressive symptoms 6. ‘Mixed’ states and ‘roughening’ 7. Mood lability/cyclothymia/‘personality-like’ behaviour 8. Predominant polarity 9.

George M Robertson in 1890 described the ‘hilarious’ and the ‘furious’ types of mania (Robertson 1890). Finally, Emil Kraepelin (1856–1926; Fig. 13) in his sixth but in more details in the eighth edition of his textbook of psychiatry in 1899 established manic–depressive illness as a distinct nosological entity and separated it from schizophrenia, on the basis of heredity, longitudinal follow-up and a supposed favourable outcome (Kraepelin 1921). In clinical terms, Kraepelin suggested that depression is characterized by lowered mood and physical and psychomotor retardation, while on the contrary, mania is characterized by elevation and acceleration of these processes.

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