Bipolar Disorders: Bipolar disorders beyond major depression and euphoric mania
The last five decades have brought essential changes and developments in psychiatry, including the discovery of antipsychotics, antidepressants, mood stabilizers, and other psychotropic substances, which have had an enormous impact on many fields of research, treatment, social life, and social politics, but also on ideological aspects and attitudes.
Abstract
The last five decades have brought essential changes and developments in psychiatry. One of the most important reasons for these developments is certainly the psychopharmacological revolution. The discovery of antipsychotics, antidepressants, mood stabilizers, and other psychotropic substances has had an enormous impact, not only on many fields of research, treatment, social life, and social politics, but also on ideological aspects and attitudes. Concerning psychiatric research, the psychopharmacological revolution has been an important and sustained stimulus not only for the development of neuroscience, genetics, and pharmacology, but also for psychiatric methodology, the development of new diagnostic concepts, and new research on treatment, prognosis, and rehabilitation. One indirect but fundamental development was the rediscovery and rebirth of old diagnostic, nosological, and phenomenological concepts. For example, new pharmacological experiences led to the rediscovery of the relevance of the unipolar–bipolar dichotomy. The concepts examined by Falret (1854), Baillarger (1854), Kleist (1929, 1953), Neele (1949), Leonhard (1957), and others were confirmed in the new psychopharmacological era, including the nosological refinements made by Jules Angst (1966), Carlo Perris (1966), Winokur and Clayton (1967), and others. But soon the enthusiasm for the new psychopharmacology gave way to an increasing awareness of some limitations. Within broadly defined diagnostic groups like schizophrenia, depression, and bipolar disorder, many patients proved to be non-responders or partial responders. The identification of such non-responder groups and their careful investigation showed some special or atypical features, like coexistence of manic and depressive symptoms or schizophrenic andmood symptoms (depressive andmanic), as well as rapid changes of mood states or rapid onset of episodes. As a result, the