A Brief History of Bipolar Disorder

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Bipolar disorder is perhaps one of the oldest known illnesses. Research reveals some mention of the symptoms in early medical records. It was first noticed as far back as the second century. Aretaeus of Cappadocia (a city in ancient Turkey) first recognized some symptoms of mania and depression, and felt they could be linked to each other. His findings went unnoticed and unsubstantiated until 1650, when a scientist named Richard Burton wrote a book, The Anatomy of Melancholia, which focused specifically on depression. His findings are still used today by many in the mental health field, and he is credited with being the father of depression as a mental illness. Jules Falret coined term "folie circulaire" (circular insanity) in 1854, and established a link between depression and suicide. His work led to the term bipolar disorder, as he was able to find a distinction between moments of depression and heightened moods. He recognized this to be different from simple depression, and finally in 1875 his recorded findings were termed Manic-Depressive Psychosis, a psychiatric disorder. Another lesser-known fact attributed to Falret is that he found the disease seemed to be found in certain families thus recognizing very early that there was a genetic link. Francois Baillarger believed there was a major distinction between bipolar disorder and schizophrenia. He characterized the depressive phase of the disease. It was this achievement that allowed bipolar disorder to receive its own classification from other mental disorders of the time. In 1913, Emil Krapelin established the term manic-depressive, with an exhaustive study surrounding the effects of depression and a small portion about the manic state. Within fifteen years, this approach to mental illness was fully accepted and became the prevailing theory of the early 1930s.
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In 1952, an article appeared in The Journal of Nervous and Mental Disorder, analyzing the genetics behind the disorder, and revealing the likelihood that manic depression ran in families already stricken with the disorder. Throughout much of the 1960s many with the disorder were institutionalized and given little help financially because of Congress refusal to recognize manic depression as legitimate illness. Only in the early 1970s were laws enacted and standards established to help those afflicted, and in 1979 the National Association of Mental Health (NAMI) was founded. In 1980, the term bipolar disorder (1980) replaced manic-depressive disorder as a diagnostic term found in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III). During the 1980s research finally was able to distinguish between adult and childhood bipolar disorder, and even today more studies are needed to find the probable causes and the possible methods to treat the illness.

What are the main features of mania?

You answered: The correct answer is: The DSM-IV Classification for mania is: a distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least one week (or any duration if hospitalisation necessary); during the period of mood disturbance three of the following have persisted (four if mood was irritable) and have been present to a significant degree: 1. Inflated self-esteem 2. Distractability 3. More talkative than usual or pressure to keep talking 4.Flight of ideas or subjective experience that thoughts are racing 5. Increase in goal directed activities or psychomotor agitation 6. Involvement in pleasurable activities that can have painful consequences 7. Decreased need for sleep. Well done!

Diagnosis
Mrs M reveals that while on holiday she was sleeping little and was full of energy. For the first time in her life she felt very attractive. She often left the husband and children behind at night and went drinking in the local clubs. This resulted in two sexual flings in one week but the husband does not know about the first. She now feels very guilty about them and that she is a bad mother. She is also worried about the fact that she does not remember whether she had unprotected sex.

What features make you think that Mrs M has a bipolar affective disorder?

You answered: The correct answer is: lack of sleep, sexual disinhibition, possible unusual use of alcohol, report of eleveated current depression Well done!

Case Study 2
Mr N is brought in by his girl friend to student health He does not understand why she has brought him in. He is in the process of organising some events for red nose day that include 'naked' rowing, 'BMX' polo and tyrolean dancing. He was up in the harbour area demonstrating this to her throughout the night. He says that he has been promised 5,000 by each shop on the waterfront and that the University will match what he raises in order to double the donation. He moves a lot during interview and speaks very fast. His girlfriend says he has been "revved up" for over a week. At one point you can not quite understand what he is saying except that he seems to believe that he has been blessed by one of St Francis' birds. When you ask him to be silent for one minute he carries on after 5 seconds. He is perfectly orientated in time person and place.

Complete the following quiz

What is your differential diagnosis?

You answered:

The correct answer is: Mania, hypomania, drug induced affective disorder, acute organic affective Hypomania is correct but really only applies when there is significant functional impairment