By Mario Maj, Hagop S. Akiskal, Juan José López-Ibor Jr., Norman Sartorius
Bipolar disease is a major psychological sickness related to episodes of significant mania and melancholy and impacts nearly one to 3 percentage of the inhabitants. based on the nationwide Institute of psychological overall healthiness approximately million members within the usa on my own are clinically determined with this disease.
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Nor are these high rates limited to psychiatric settings; at least one such report has come from a family practice clinic . Moreover, according to Simpson et al , bipolar II disorder may represent the most common phenotype of bipolar disorder. The French National EPIDEP study , based on a sample from a variety of clinical settingsÐprivate and public, inpatient and outpatient, academic and general psychiatric sectorÐhave provided the most compelling data on the high prevalence of bipolar II disorder among patients with major depression.
In addition, the index depressive episode was further characterized by such features as phobic anxiety, interpersonal sensitivity, obsessive-compulsive symptoms, somatization (with subpanic symptoms), worse in evening, self-pity, demandingness, subjective or overt anger, jealousy, suspiciousness, and ideas of referenceÐagain testifying to a broad meÂlange of ``atypical'' depressive symptoms with ``borderline'' taint. Temperamental attributes obtained at index interview proved decisive (sensitivity 91%) in identifying those who switched from depression to hypomania: these attributes consisted of trait ``mood lability'', ``energyactivity'', and ``daydreaming'' (all characteristic of Kretschmer's description of the cyclothymic temperament).
However, hyperthymic traits do precede manic episodes, and can be retrospectively examined. An excellent description of the biographical features of this temperamentÐbased on systematic chart review of manic patients in MunichÐis provided by Possl and von Zerssen : vivid, active, extraverted; verbally aggressive, self-assured; strong-willed; self-employed; risk-taking; sensation-seeking; breaking social norms; generous and spendthrift. 9 The hyperthymic temperament (expanded from Akiskal and Mallya ) Four or more of the following attributes, which are not episode-bound and constitute part of the habitual long-term functioning of the individual: .