La eternidad es una de las raras virtudes de la literatura.
Raffaello Sanzio, Le Tre Grazie, 1505.
Despite the heterogeneity in both the bipolar and unipolar groups, the breadth of reported ipolar–unipolar diVerences is impressive. They include four separate spheres of data-enetic,clinical, biological and pharmacological. Bipolar and recurrent unipolar disorders,nevertheless, appear to be very similar in some important respects (e.g., prophylactic response to lithium). Taken together, the data suggest that they are best considered as two subgroups of manic-depressive illness rather than separate and distinct illnesses.
The available data also support a continuum model, with ‘‘pure’’ bipolar illness at one end and unipolar illness at the other.In the 15 years since the Goodwin and Jamison review, the separation of unipolar and bipolar depression has been increasingly questioned, and the diffculty in separating mood disorder patients into two clusters is exemplified by evidence of frequent misclassification. A review of the records of 48 patients identified as having bipolar disorder and 4 patients considered schizoaVective disorder (bipolar type) found that 40% (19/48) were previously diagnosed with a unipolar major depressive disorder. An average of 7.5 years elapsed before the patients were relabeled as suffering from bipolar disorder. Over the course of illness, depression was the predominant mood disturbance found in a literature review assessing the incidence of depressive phases of patients with bipolar disorder.
The authors concluded that the label of bipolar disorder is more often associated with psychosis, melancholia, psychomotor retardation, ‘‘atypical’’ symptoms, and higher suicide rates, and that the depressed phase is the major contributor to the disability in this illness. This understanding follows the conclusion by Taylor and Abrams (1980; Taylor et al., 1980) that mood disorders should be separated by the presence or absence of melancholia and not by the presence of mania or hypomania.Psychopathologic studies of unipolar and bipolar disorder are rife, with overlaps in psychopathology, course of illness, and family illness. An examination of patients with rapid-cycling mood disorder found major depression in 85% and salient manic features were identified in at least half the patients with recurrent depression.
An assessment of depressive features in 36 patients with bipolar disorder and 37 patients with unipolar major depressive disorder was unable to separate the two groups. The authors concluded that ‘‘bipolar disorder is characterized by some depressive features less likely to be found in unipolar depression,’’ but that otherwise the two conditions are alike. In yet another study, a sample of 313 patients with bipolar I disorder with an index episode of depression, signs of agitated depression were readily identified in 61 (20%) as the only distinction from recurrent depressive illness.
The available data also support a continuum model, with ‘‘pure’’ bipolar illness at one end and unipolar illness at the other.In the 15 years since the Goodwin and Jamison review, the separation of unipolar and bipolar depression has been increasingly questioned, and the diffculty in separating mood disorder patients into two clusters is exemplified by evidence of frequent misclassification. A review of the records of 48 patients identified as having bipolar disorder and 4 patients considered schizoaVective disorder (bipolar type) found that 40% (19/48) were previously diagnosed with a unipolar major depressive disorder. An average of 7.5 years elapsed before the patients were relabeled as suffering from bipolar disorder. Over the course of illness, depression was the predominant mood disturbance found in a literature review assessing the incidence of depressive phases of patients with bipolar disorder.
The authors concluded that the label of bipolar disorder is more often associated with psychosis, melancholia, psychomotor retardation, ‘‘atypical’’ symptoms, and higher suicide rates, and that the depressed phase is the major contributor to the disability in this illness. This understanding follows the conclusion by Taylor and Abrams (1980; Taylor et al., 1980) that mood disorders should be separated by the presence or absence of melancholia and not by the presence of mania or hypomania.Psychopathologic studies of unipolar and bipolar disorder are rife, with overlaps in psychopathology, course of illness, and family illness. An examination of patients with rapid-cycling mood disorder found major depression in 85% and salient manic features were identified in at least half the patients with recurrent depression.
An assessment of depressive features in 36 patients with bipolar disorder and 37 patients with unipolar major depressive disorder was unable to separate the two groups. The authors concluded that ‘‘bipolar disorder is characterized by some depressive features less likely to be found in unipolar depression,’’ but that otherwise the two conditions are alike. In yet another study, a sample of 313 patients with bipolar I disorder with an index episode of depression, signs of agitated depression were readily identified in 61 (20%) as the only distinction from recurrent depressive illness.
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