Bipolar Disorders

100 years after manic-depressive insanity

Bipolar Disorders100 years after manic-depressive insanity

Edited by

Andreas MarnerosMartin-Luther-University Halle-Wittenberg, Halle, Germany

andJules Angst

University Zürich, Zürich, Switzerland

KLUWER ACADEMIC PUBLISHERS NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW

eBook ISBN: 0-306-47521-9Print ISBN: 0-7923-6588-7

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Contents

List of contributors ix

Acknowledgements xiii

Preface xv

1

2

3

4

5

6

7

8

9

Bipolar disorders: roots and evolutionAndreas Marneros and Jules Angst 1

The soft bipolar spectrum: footnotes to Kraepelin on theinterface of hypomania, temperament and depressionHagop S. Akiskal and Olavo Pinto

The mixed bipolar disordersSusan L. McElroy, Marlene P. Freeman and Hagop S. Akiskal

Rapid-cycling bipolar disorderJoseph R. Calabrese, Daniel J. Rapport, Robert L. Findling,Melvin D. Shelton and Susan E. Kimmel

Bipolar schizoaffective disordersAndreas Marneros, Arno Deister and Anke Rohde

Bipolar disorders during pregnancy, post partum and inmenopauseAnke Rohde and Andreas Marneros

Adolescent-onset bipolar illnessStan Kutcher

Bipolar disorder in old ageKenneth I. Shulman and Nathan Herrmann

Temperament and personality types in bipolar patients:a historical reviewJules Angst

37

63

89

111

127

139

153

175

viii Contents

10

11

12

13

14

15

16

17

18

19

20

21

22

23

Interactional styles in bipolar disorderChristoph Mundt, Klaus T. Kronmüller and Matthias Backenstraß

Comorbidity in bipolar affective disorderPeter Brieger

The genetic epidemiology of bipolar disorderMing T. Tsuang and Stephen V. Faraone

Genetics of bipolar affective disorderHenrik Ewald

The biology of bipolar disorderMary J. Kujawa and Charles B. Nemeroff

Cyclicity and manic-depressive illnessAthanasios Koukopoulos, Gabriele Sani, Alexia Koukopoulos andPaolo Girardi

Bipolar shifts as disorders of the bi-hemispheric integration oflanguage: implications for the genetic origins of the psychoticcontinuumTimothy J. Crow

Mood stabilizers in bipolar disorderMario Maj, Alfonso Tortorella and Luca Bartoli

Antipsychotics in acute maniaMauricio Tohen

Antidepressant treatment of bipolar depressionHans-Jürgen Möller and Heinz Grunze

The prognosis of bipolar disorders: course and outcomeMarc L. Bourgeois and Andreas Marneros

The costs of treatment of bipolar disorderPaul E. Keck, Susan L. McElroy, Lesley M. Arnold,Naakesh A. Dewan and Jerry A. Bennett

Bipolar disorder and schizophrenia. Unifying the concept ofpsychosis through brain morphologyLynn E. DeLisi

On entities and continuities of bipolar disordersAndreas Marneros

Index

201

215

231

243

281

315

335

349

373

387

405

437

449

461

465

Contributors

Hagop S. AkiskalUniversity of California at San Diego, 3350 La Jolla Village, San Diego, CA92161, USA

Jules AngstPsychiatrische Universitätsklinik, Lenggstraße 31, Postfach 68, 8209 Zürich,Switzerland

Lesley M. ArnoldDepartment of Psychiatry, University of Cincinnati College of Medicine,Ohio 45267-0559, USA

Matthias BackenstraßPsychiatrische Klinik der Ruprecht-Karls-Universität Heidelberg, Voßstraße 4,69115 Heidelberg, Germany

Luca BartoliClinica Psichiatrica, Primo Policlinico Universitario, Largo Madonna delleGrazie, I-80138 Napoli, Italy

Jerry A. BennettDepartment of Psychiatry, University of Cincinnati College of Medicine,Ohio 45267-0559, USA

Marc L. BourgeoisProfesseur Université Bordeaux II, Hôpital Charles Perrens, 121, rue de laBéchade, 33076 Bordeaux, France

Peter BriegerKlinik und Poliklinik für Psychiatrie und Psychotherapie der Martin-Luther-Universität Halle-Wittenberg, 06097 Halle, Germany

Joseph R. CalabreseProfessor of Psychiatry, Department of Psychiatry, Case Western ReserveUniversity School of Medicine, University Hospitals of Cleveland, Ohio,USA

x Contributors

Tim J. CrowUniversity of Oxford, Department of Psychiatry, Warneford Hospital,Oxford OX3 7JX, UK

Arno DeisterKrankenhaus Itzehoe, Abteilung für Psychiatrie und Psychotherapie,Robert-Koch-Straße 2, 25524 Itzehoe, Germany

Lynn E. DeLisiProfessor of Psychiatry, SUNY, Stony Brook HSC, T-10 Stony Brook, NewYork 11794, USA

Naakesh A. DewanDepartment of Psychiatry, University of Cincinnati College of Medicine,Ohio 45267-0559, USA

Henrik EwaldÅrhus Universitetshospital, Psykiatrisk Hospital, Institute for BasicPsychiatric Research, Skovagervej 2, 8240 Risskov, Denmark

Stephen V. FaraonePediatric Psychopharmacology Unit, Psychiatry Service, MassachusettsGeneral Hospital, Boston, MA 02114, USA

Robert L. FindlingCase Western Reserve University School of Medicine, University Hospitalsof Cleveland, Ohio, USA

Marlene P. FreemanUniversity of Cincinnati Medical Center, 231 Bethesda Avenue, Cincinnati,Ohio 45267-0559, USA

Paolo GirardiCentro Lucio Bini, Via Crescenzio 42, 00193 Roma, Italy

Heinz GrunzePsychiatrische Universitätsklinik der Universität München, Nußbaumstraße 7,80336 München, Germany

Nathan HerrmannHead, Department of Psychiatry, Sunnybrook of Toronto, 2075 BayviewAvenue, North York, Ontario, M4N 3M5, Canada

Paul E. Keck Jr.Department of Psychiatry, University of Cincinnati College of Medicine,Ohio 45267-0559, USA

Contributors xi

Susan E. KimmelCase Western Reserve University School of Medicine, University Hospitalsof Cleveland, Ohio, USA

Alexia E. KoukopoulosUniversità degli Studî di Roma, "La Sapienza" – 5, Piazzale Aldo Moro,00185 Roma, Italy

Athanasios KoukopoulosCentro Lucio Bini, Via Crescenzio 42, 00193 Roma, Italy

Klaus T. KronmüllerPsychiatrische Klinik der Ruprecht-Karls-Universität Heidelberg, Voßstraße 4,69115 Heidelberg, Germany

Mary J. KujawaMedical Director, Neurosciences Medical Development, Bristol-MyersSquibb Company, Princeton, New Jersey 08543-4500, USA

Stanley P. KutcherDepartment of Psychiatry, Dalhousie University, Queen Elizabeth II HealthSciences Center, 5909 Veterans' Memorial Lane, Halifax, Nova ScotiaB3H 3E2, Canada

Mario MajClinica Psichiatrica, Primo Policlinico, Universitario, Largo Madonna delleGrazie, I-80138 Napoli, Italy

Andreas MarnerosKlinik und Poliklinik für Psychiatrie und Psychotherapie der Martin-Luther-Universität Halle-Wittenberg, 06097 Halle, Germany

Susan L. McElroyDepartment of Psychiatry, University of Cincinnati College, of Medicine,Ohio 45267–0559, USA

Hans-Jürgen MöllerPsychiatrische Universitätsklinik der Universität München, Nußbaumstraße7, 80336 München, Germany

Christoph MundtGeschäftsführender Direktor, Psychiatrische Klinik, R.-Karl-UniversitätHeidelberg, Voßstraße 4, 69115 Heidelberg, Germany

Charles B. NemeroffDepartment of Psychiatry and Behavioral Sciences, Emory School ofMedicine, Atlanta, Georgia, USA

xii Contributors

Olavo PintoDepartment of Psychiatry, University of California at San Diego, 9500Gilman Drive, La Jolla, CA 92093-0603, USA

Daniel J. RapportCase Western Reserve University School of Medicine, University Hospitalsof Cleveland, Ohio, USA

Anke RohdeGynäkologische Psychosomatik Universitätsklinik, Sigmund-Freud-Straße25, 53100 Bonn, Germany

Gabriele SaniUniversità degli Studî di Roma, "La Sapienza" – 5, Piazzale Aldo Moro,00185 Roma, Italy

Melvin D. SheltonCase Western Reserve University School of Medicine, University Hospitalsof Cleveland, Ohio, USA

Kenneth I. ShulmanHead, Department of Psychiatry, Sunnybrook & Women's, 2075 BayviewAvenue, North York, Ontario, M4N 3M5, Canada

Mauricio TohenZyprexa Global Physician, Lilly Research Laboratories, Lilly CorporateCenter, Indianapolis, Indiana 46285, USA

Alfonso TortorellaClinica Psichiatrica, Primo Policlinico, Universitario, Largo Madonna delleGrazie, I-80138 Napoli, Italy

Ming T. TsuangHarvard Medical School, Massachusetts Mental Health Center, 74 FenwoodRoad, Boston, MA 02115, USA

Acknowledgements

The publication of this book would have been impossible without thegenerous support of the LILLY Company in Germany. Nienke Kingma,especially, was enthusiastically involved in the realization of this publicationand in the workshop on which this book is based. The editors and authorsof this book are very grateful to her, as well as to LILLY Germany. We alsothank Friederike Reis-Zelger from LILLY for her efforts in organizing theworkshop, as well as Ina Nelles, assistant to Professor Marneros, for manag-ing the manuscripts. We also thank Kluwer Academic Publishers group fortheir uncomplicated and friendly cooperation.

Preface

One hundred years ago – in 1899 – Emil Kraepelin, Professor of Psychiatryin Heidelberg and later in Munich – created, in two very important piecesof work, the concept of "manisch-depressives Irresein" ("manic-depressiveinsanity"). The first was entitled Die klinische Stellung der Melancholie (TheClinical Position of Melancholia), and the second publication was the sixthedition of his textbook. In the same year Kraepelin's pupil and colleague,Wilhelm Weygandt, published his book Über die Mischzustände des Manisch-Depressiven Irreseins (On the Mixed States of Manic-Depressive Insanity).

A century after Kraepelin's creation of "manic-depressive insanity", wecelebrate. Is this really appropriate? We believe it is firmly established that the"folie circulaire" of Jean-Pierre Falret or the "folie à double forme" of JulesBaillarger differs from recurrent depression, which is also different fromKraepelin's "manic-depressive insanity". Yet the answer to the question of

xvi Preface

whether it is appropriate to celebrate is clear: Yes. This not only because thework of Emil Kraepelin is fundamental in the true sense of the word. Therecan be no doubt that Emil Kraepelin is the most important founder of modernpsychiatry. Just one of the many reasons for this opinion is his enormouscontribution to the definition, description and diagnosis of affective disorders.

Emil Kraepelin is one of the most interesting personalities of internationalscience. Not only because of his knowledge, and not only because of his verybroad range of interests; not only because his knowledge was always basedon data, on observations and clinical experience; and not only because hethought conceptually; but also because he had a marvellous character trait:namely the ability to correct himself. He was always able to change his opinion,always able to revise his theories if data-oriented research no longer supportedhis assumptions. He followed the principle: "Science does not follow books,but books science". An example: the change in his views regarding"Involutionsmelancholie" (melancholia in the elderly) after the findings of hispupil and colleague Dreyfus did not confirm the independence of this melan-cholia from the other types of "manic-depressive insanity". Another example:when another of his former pupils, Zendig, examined patients diagnosed byKraepelin himself as having schizophrenia (dementia praecox), and foundthat 20% of them did not fulfil the essential longitudinal Kraepelinian criterionof deterioration, Kraepelin accepted it. In his 1920 publication "Die

Preface xvii

Erscheinungsformen des Irreseins" ("The Phenomenological Types ofInsanity") he documented his doubts with regard to the validity of a sharpdichotomy between schizophrenia and the affective disorders, leaving roomfor cases-in-between, the disorders later named schizoaffective. UnfortunatelyEmil Kraepelin's ability to correct himself was not always a trait shared byhis epigones, who were in the main more dogmatic than Kraepelin himself.The consequence was that, in spite of the significant opposition to the unitaryconcept of Kraepelin by psychiatrists such as Carl Wernicke, Karl Kleist andKarl Leonhard, almost seven decades passed before the rebirth of the "foliecirculaire".

In 1999 we celebrated not only 100 years of Kraepelin's concept of themanic-depressive insanity, but also the 33rd anniversary – 33 years being oneof the definitions of a "generation" – of the rebirth of the bipolar disorders.The year of their rebirth was 1966, the date of two fundamental publications:the monograph Zur Ätiologie und Nosologie endogener depressiver Psychosen (Onthe Aetiology and Nosology of Endogenous Depressive Psychoses) by Jules Angst,and some months later Carlo Perris' publication "A study of bipolar (manic-depressive) and unipolar recurrent depressive psychoses".

During the past 33 years the concept of the bipolar disorders has been firmlyestablished; the views of Falret, Wernicke, Kleist, Leonhard, Angst and Perrishave become important component parts of the psychiatric knowledge andhave been developed further.

One hundred years of exciting evolution!

Andreas Marneros Jules AngstHalle (Saale) ZurichAutumn 1999

References

Angst J. Zur Ätiologie und Nosologie endogener depressiver Psychosen. Eine gen-etische, soziologische und klinische Studie. Berlin, Heidelberg, New York:Springer, 1966.

Kraepelin E. Die klinische Stellung der Melancholie. Mschr Psychiatr Neurol.1899a;6:325–35.

Kraepelin E. Psychiatrie. 6. Auflage. Leipzig: Barth, 1899b.Kraepelin E. Die Erscheinungsformen des Irreseins. Z Gesamt Neurol Psychiatrie.

1920;62:l–29.Marneros A. Handbuch der unipolaren und bipolaren Erkrankungen. Stuttgart:

Thieme, 1999a.Marneros A. (ed.) Late-Onset Mental Disorders. The Potsdam Conference. London:

Gaskell, 1999b.Perris C. A study of bipolar (manic-depressive) and unipolar recurrent depressive

psychoses. Acta Psychiatr Scand. 1966;194(Suppl.):1–89.