manic-depressive illness


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Related to manic-depressive illness: bipolar disorder, rapid cycling, Bipolar depression

man·ic-de·pres·sive ill·ness

an older term for manic-depressive disorder, which is called bipolar disorder (q.v.) in the current edition of Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.

bipolar disorder

A mental condition characterised by episodic mania (euphoria) alternating with bouts of depression, which affects 1% of the general population. Bipolar disorder (BD) is the term used by the American Psychiatric Association, and is an umbrella term that encompasses a variety of clinical subtypes. The synonym manic-depressive disorder is still popular.

Epidemiology
BD first appears by age 30; half of patients have 2–3 episodes during life, each from 4–13 months in duration.
 
Clinical findings
Mood swings in BD may be dramatic and rapid, but more often are gradual; manic episodes are characterised by disordered thought, judgment and social behaviour; unwise business or financial decisions may be made when an individual is in a manic phase.

Management
Lithium prevents or attenuates manic and depressive episodes, maintained at 0.8–1.0 mmol/L; if the manic episode is unresponsive, electroconvulsive therapy may be effective.

Bipolar disorder, DSM-IV subtypes
Bipolar I disorder—characterised by an occurrence of one or more manic episodes or mixed episodes, and one or more major depressive episodes, and an absence of episodes better accounted for by schizoaffective, delusional or psychotic disorders.
 
Bipolar II disorder—recurrent major depressive episodes with hypomanic episodes, characterised by one or more major depressive episodes, one or more hypomanic episodes, and an absence of manic or mixed episodes or other episodes better accounted for by schizoaffective, delusional or psychotic disorders. Bipolar II patients suffer from greater psychomotor agitation, guilt, shame and suicidal ideation, attempts and success. 

Demographics
0.5% prevalence in the general population; a familial tendency; more common in women.
 
Mortality
10–15% die from suicide
 
Cyclothymia—a mild form of bipolar II disorder, consisting of recurrent mood disturbances between hypomania and dysthymic mood. A single episode of hypomania is sufficient to diagnose cyclothymia, but most people with it also have dysthymic periods. The diagnosis of cyclothymic disorder is not made if there is a history of mania or major depressive episode or mixed episode.

Bipolar disorder, NOS (Sub-threshold bipolar disorder)—bipolar disorder, NOS, is a waste-paper basket category used to indicate bipolar illness that does not fit into any of the above three formal DSM-IV bipolar diagnostic categories. The patient is so labeled if he or she manifests part of the bipolar spectrum symptoms (e.g. some manic and depressive symptoms) but does not meet the criteria for one of the above subtypes.

manic-depressive illness

Bipolar I disorder, see there.

manic-depressive illness

More commonly referred to as bipolar disorder, this is an emotional (affective) disorder of unknown cause featuring an association of abnormal elation (mania) and pathological depression. The depressive phase usually comes first and for 6 to 12 months there is mental and physical slowing, loss of interest and energy, sadness, pessimism, self-blame and thoughts of suicide. Five or six such episodes usually occur over a period of about 20 years. The manic phase, if it occurs, usually follows two to four depressive episodes. It features speeding up of thought and speech, inappropriate elation, disordered judgement, ever-changing flights of ideas, grandiose notions, unrealistic plans and sometimes socially or financially ruinous behaviour. The spontaneous recovery rate in manic-depressive illness is about 90%. Treatment is with antidepressant drugs and, in the manic phase, with LITHIUM.

bi·po·lar dis·or·der

(bī-pō'lăr dis-ōr'dĕr)
Affective disorder characterized by occurrence of alternating manic, hypomanic, or mixed episodes and with major depresive episodes.
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