Bipolar spectrum

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The complete bipolar spectrum includes the a range of mood disorders, ranging from recurrent unipolar depression all the way to bipolar disorder with psychotic features (or schizobipolar disorder). Anxiety disorders may typically occur at all points across this spectrum.

Diagnostic information about soft bipolar disorder, a part of the bipolar spectrum, is available by clicking [here].

According to KR Jamison in Touched with Fire, "The ... reality of manic-depressive illness is far more lethal and infinitely more complex than the current psychiatric nomenclature, bipolar disorder, would suggest. Cycles of fluctuating moods and energy levels serve as a background to constantly changing thoughts, behaviors, and feelings. The illness encompasses the extremes of human experience. Thinking can range from florid psychosis, or "madness," to patterns of unusually clear, fast and creative associations, to retardation so profound that no meaningful mental activity can occur. Behavior can be frenzied, expansive, bizarre, and seductive, or it can be seclusive, sluggish, and dangerously suicidal. Moods may swing erratically between euphoria and despair or irritability and desperation. The rapid oscillations and combinations of such extremes result in an intricately textured clinical picture."

A simple nomenclature system was introduced in 1978, although there are others, by Angst, J., et al, to easier label individuals' affectedness within the spectrum, following a clinical study by the Psychiatric University Clinic of Zurich.

Points on the spectrum using this nomenclature are denoted using the following codes:

'M' severe mania
'D' severe depression (unipolar depression)
'm' less severe mania (hypomania)
'd' less severe depression

Thus, 'mD' represents a case with hypomania and major depression. A further distinction is sometimes made in the ordering of the letters, to represent the order of the episodes, where the patient's normal state is euthymic, interrupted by episodes of mania followed by depression ('MD') or vice versa ('DM').

On this scale, major depression would be denoted as 'D'. Unipolar mania ('M') is, depending on the authority cited, either very rare, or nonexistent with such cases actually being 'Md'.

Unipolar hypomania ('m') without accompanying depression is not observed in the medical literature. There is speculation as to whether some high-achieving individuals are actually 'm', with their successful social functioning keeping them out of sight of the mental health profession.

Although it is officially considered a personality disorder rather than an affective/mood disorder, some experts advocate adding borderline personality disorder (BPD) to the bipolar spectrum. BPD has a lot of similarities to rapid-cycling bipolar type II and other depressive disorders, and many patients show a positive response to the same types of medication.

References

Angst J, Felder W, Frey R, Stassen HH. Arch Psychiatr Nervenkr. 1978 Oct 9;226(1):57-64. The course of affective disorders. I. Change of diagnosis of monopolar, unipolar, and bipolar illness. (PMID 708227)

Jamison, Kay R. Touched with Fire: Manic-Depression and the Artistic Temperament. 1996. ISBN

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