The Bipolar Spectrum

Abstract

As mentioned above, a significant number of patients are initially diagnosed as suffering from unipolar depression, and latter, when mania or hypomania emerges, the diagnosis is changed to bipolar disorder. This essentially poses another question, concerning the diagnosis of cases with subthreshold manic symptoms or long-lasting hyperthymia. These patients are reported to be refractory to standard therapeutic approaches. While the traditional bipolar vs. unipolar distinction is widely used and adopted by classification systems, it is doubtful whether it can capture the essence of the huge heterogeneity observed in mood disorders and their dynamic nature with frequent switches and changes in the clinical profile. The greatest disadvantage of both classification systems is that they perform better (and focus) when interepisodic remission is present; instead, the everyday real-life patients is more likely to suffer from a chronic disorder with residual and mixed symptoms. A dimensional concept (from normal to pathological) was proposed by Kretschmer in 1921 for schizophrenia (schizothymic–schizoid–schizophrenic) and for affective disorders (cyclothymic temperament–cycloid ‘psychopathy’–manic–depressive disorder) as well as by Bleuler in 1922. The term ‘spectrum’ was first used in psychiatry in 1968 for the schizophrenia spectrum. However, the mood spectrum is solidly embedded in the spectrum of functional psychoses, including schizophrenia and schizoaffective and affective disorders. There is growing clinical evidence that the spectrum approach, with its dimensional nature, offers a real alternative to the traditional Kraepelinian dichotomy of schizophrenia v. manic–depressive insanity and the unipolar–bipolar dichotomy.