Clinical Pictures of Phasic Psychoses (without Cycloid Psychoses)
Until very recently nearly all psychiatrists were united in the opinion that manic and depressive disease pictures were all part of manic-depressive illness. It was the work of ANGST (1966) and PERRIS (1966) that helped spread my theory that unipolar and
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Until very recently nearly all psychiatrists were united in the opinion that manic and depressive disease pictures were all part of manic-depressive illness. It was the work of ANGST (1966) and PERRIS (1966) that helped spread my theory that unipolar and bipolar diseases were separable. I carried out my first investigations together with NEELE. KLEIST (1943), with whom we were working, shared my opinion. Previously, KLEIST had claimed that there was no independent manic-depressive illness, but rather only melancholia and mania with a certain reciprocal affinity. Thus he had already postulated the independence of the unipolar forms, but had gone too far by denying the independent existence of manic-depressive illness. The genetic difference between the unipolar and bipolar forms was seen in that the manic-depressive form had a significantly higher rate of psychoses among relatives than did unipolar forms. WINOKUR (1969) and others followed in this line of thinking. However the two disease forms also have different clinical pictures. The bipolar form displays a considerably more colorful appearance; it varies not only between the two poles, but in each phase offers different pictures. The unipolar forms, of which there are several (ANGST, PERRIS, WINOKUR do not treat this) return, in a periodic course, with the same symptomatology. Every individual form is characterized by a syndrome associated with no other form. On the other hand, in bipolar cases no clear syndromes can be described since there are many transitions between various formations and the picture may even shift during one phase. Thus, one can generally recognize a bipolar form during the first phase. In the same sense, bipolar forms may be recognized as such when there is only an accidental swing toward one pole but where the potential toward the other pole exists. Consequently the differentiation is more easily made between polymorphic (bipolar) and pure (unipolar) forms. The number of polymorphic disease forms with no tendency at all to the opposite phase is very small, insofar as attention is paid to minor indications. Not infrequently the opposite phase will merely be hinted at, though it cannot fail to be recognized. Manic patients may have a depressive mood for hours, depressive patients as their depression disappears may show excitement with gaiety and overactivity. Both do not have to be regarded as the expression of separate phases, but these variations do show the disease potential toward the other pole. Furthermore, depressive patients may often be excited by encouragement and led out of their depression. They become lively, talkative, with hardly a sign of the depressed mood. H. Beckmann et al. (eds.), Classification of Endogenous Psychoses and their Differentiated Etiology © Springer-Verlag/Wien 1999
Manic-Depressive Illness
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In fact a patient during such an encouraging discussion may become so lively that eventually he might be described as hypomanic. Mterwards the depressive mood returns. In the unipolar forms there are no signs oflab
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