Clinical Course of Affective Disorders

Conference paper


Studies on the course of affective disorders have an impressive tradition that spans about 100 years. The classification has changed over these years and we can roughly distinguish three periods. The first begins with Falret’s (1851) definition of bipolar disorders and the distinction between depression and bipolar illness. In 1889, Kraepelin unified all subgroups of affective disorders of patients suffering from either mania or depression, or both, and termed this the “manic-depressive psychosis.” His influence dominated until the late 1960s when the papers of Leonhard et al. (1962), Angst (1966), Perris (1966), and Winokur and Clayton (1967) suggested a return to differentiating between monopolar, or unipolar, depression and bipolar disorder. Thus homogeneous subgroups such as mania or depression were mainly studied during the first of the aforesaid periods and during the past 20 years. The interest in studies on the course of affective disorders has greatly increased as a spin-off of the introduction of long-term medication and prophylaxis. From the therapeutic point of view, two questions arise: which patients should be selected for longterm medication, considering the relapse risk, and how long should such longterm medication be maintained, considering recurrence and the possibility of a burning out of the disorder in old age. Furthermore, the risks of long-term medication have to be weighed against the risks of nonrecovery or chronicity, social consequences of the disorder, and increased mortality or suicide.


Affective Disorder Suicide Rate Unipolar Depression Depressive Illness Bipolar Affective Disorder 
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© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  1. 1.Psychiatrische UniversitätsklinikZürich 8Germany

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