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Bipolar Disorders
Mixed States, Rapid-Cycling, and Atypical Forms

Bipolar disorder manifests itself in a variety of forms. It can coexist with other psychiatric
conditions, and treatment efficacy can depend on the type of bipolar state. This book covers the
full range of mixed states, rapid-cycling, and transient forms of bipolar disorder, from atypical
and agitated depression to schizoaffective mixed states. The most recent ICD and DSM
categories are covered, and the authors also look at the biology and genetics of bipolar disorder,
along with issues relating to age (children and the elderly), comorbidity, choice of drug
treatment, and investigational strategies.

Andreas Marneros is Professor of Psychiatry and Head of the Department of Psychiatry and
Psychotherapy at the Martin-Luther University in Halle-Wittenberg, Germany. Among other
awards, he won the Kraepelin Research Prize in 2002 for his work in the psychoses, especially
schizoaffective and acute brief psychoses. He is the author of the German Handbook of Bipolar
and Depressive Disorders.

Frederick K. Goodwin is based in the Department of Psychiatry at the George Washington
University, Washington, DC, USA. He is a well-known media consultant for issues relating to
bipolar disorder and collaborated with Kay Jamison in their book Manic-Depressive Illness, the
first psychiatry book to win the Best Medical Book award from the Association of American
Bipolar Disorders
Mixed States, Rapid-Cycling,
and Atypical Forms

Edited by

Andreas Marneros
Martin-Luther University Halle-Wittenberg
Halle, Germany


Frederick K. Goodwin
George Washington University Medical Center
Washington, DC, USA
cambridge university press
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo

Cambridge University Press
The Edinburgh Building, Cambridge cb2 2ru, UK
Published in the United States of America by Cambridge University Press, New York
Information on this title: www.cambridge.org/9780521835176

© Cambridge University Press 2005

This publication is in copyright. Subject to statutory exception and to the provision of
relevant collective licensing agreements, no reproduction of any part may take place
without the written permission of Cambridge University Press.

First published in print format 2005

isbn-13 978-0-511-12929-2 eBook (EBL)
isbn-10 0-511-12929-7 eBook (EBL)

isbn-13 978-0-521-83517-6 hardback
isbn-10 0-521-83517-8 hardback

Cambridge University Press has no responsibility for the persistence or accuracy of urls
for external or third-party internet websites referred to in this publication, and does not
guarantee that any content on such websites is, or will remain, accurate or appropriate.

Every effort has been made in preparing this publication to provide accurate and
up-to-date information that is in accord with accepted standards and practice at the time
of publication. Nevertheless, the authors, editors and publisher can make no warranties
that the information contained herein is totally free from error, not least because clinical
standards are constantly changing through research and regulation. The authors, editors
and publisher therefore disclaim all liability for direct or consequential damages
resulting from the use of material contained in this book. Readers are strongly advised
to pay careful attention to information provided by the manufacturer of any drugs or
equipment that they plan to use.

List of contributors page vii
Preface xi

1 Bipolar disorders beyond major depression and euphoric mania 1
Andreas Marneros and Frederick K. Goodwin

2 Emerging concepts of mixed states: a longitudinal perspective 45
Giulio Perugi and Hagop S. Akiskal

3 Rapid-cycling bipolar disorder 61
Omar Elhaj and Joseph R. Calabrese

4 Bipolar I and bipolar II: a dichotomy? 88
Eduard Vieta, M. Reinares, and M. L. Bourgeois

5 Recurrent brief depression as an indicator of severe mood disorders 109
Jules Angst, Alex Gamma, Vladeta Ajdacic, Dominique Eich, Lukas Pezawas,
and Wulf Rossler

6 Atypical depression and its relation to bipolar spectrum 131
Franco Benazzi

7 Agitated depression: spontaneous and induced 157
Athanasios Koukopoulos, Gabriele Sani, Matthew J. Albert, Gian Paolo Minnai, and
Alexia E. Koukopoulos

8 Schizoaffective mixed states 187
¨ ¨
Andreas Marneros, Stephan Rottig, Andrea Wenzel, Raffaela Bloink, and Peter Brieger

9 Acute and transient psychotic disorder: an atypical bipolar disorder? 207
Andreas Marneros, Frank Pillmann, Stephan Rottig, Andrea Wenzel,
and Raffaela Bloink

vi Table of Contents

10 Bipolar disorder in children and adolescents 237
Boris Birmaher and David Axelson

11 Atypical features of bipolarity in old age 252
Kenneth I. Shulman

12 Comorbidity in mixed states and rapid-cycling forms of bipolar disorders 263
Peter Brieger

13 Challenges in the genetics of bipolar disorder 277
Kathleen Merikangas and Kelly Yu

14 Biological aspects of rapid-cycling and mixed states 311
Heinz Grunze and Jorg Walden

15 The treatment of bipolar mixed states 324
John Cookson and Saad Ghalib

16 The use of atypical antipsychotic agents in the treatment of diagnostic
subgroups of bipolar disorder: mixed and pure states, psychotic and
non-psychotic 353
Robert W. Baker, Leslie M. Schuh, and Mauricio Tohen

17 Investigational strategies: treatment of rapid cycling, mixed episodes,
and atypical bipolar mood disorder 369
Gary Sachs and Mandy Graves

Index 386

Valadeta Ajdacic PhD David Axelson MD
Psychiatrische Universitatsklinik University of Pittsburgh Medical Center
Lenggstraße 31 Western Psychiatric Institute and Clinic
8008 Zurich Department of Psychiatry
Switzerland 3811 O™Hara Street
Pittsburgh PA 15213
Hagop S. Akiskal MD USA
University of California at San Diego
3350 La Jolla Village Robert W. Baker
San Diego CA 92161 Lilly Research Laboratories
USA Lilly Corporate Center
Indianapolis IN 46285
Matthew J. Albert USA
Centro Lucio Bini
Center for the Treatment and Research of Franco Benazzi MD PhD
Affective Disorders via Pozzetto 17
Via Crescenzio 42 48010 Castiglione
00193 Rome Cervia RA
Italy Italy

Jules Angst MD Dr hc Boris Birmaher MD
Psychiatrische Universitatsklinik University of Pittsburgh
Lenggstraße 31 Western Psychiatric Institute and Clinic
8008 Zurich Department of Psychiatry
Switzerland 3811 O™Hara Street
Pittsburgh PA 15213

viii List of contributors

Raffaela Bloink PhD Omar Elhaj MD
Department of Psychiatry and Department of Psychiatry
Psychotherapy Case Western Reserve University
Martin-Luther University Halle-Wittenberg Mood Disorders Program
06097 Halle University Hospitals of Cleveland
Germany Cleveland OH
M. L. Bourgeois MD
Alex Gamma PhD
Universite Bordeaux II
Psychiatrische Universitatsklinik
121 rue de la Bechade
Lenggstraße 31
8008 Zurich
Peter Brieger MD
Saad Ghalib
Klinik und Poliklinik fur Psychiatrie und
Royal London Hospital
St Clement™s
Martin-Luther University Halle-Wittenberg
2A Bow Road
06097 Halle
London E3 4LL
Joseph Calabrese MD
Frederick K. Goodwin MD
Department of Psychiatry
Center of Neuroscience, Medical Progress,
Case Western Reserve University
and Society
School of Medicine
Department of Psychiatry
University Hospitals of Cleveland
George Washington University
Cleveland OH
2150 Pennsylvania Ave NW
Washington DC 20037
John Cookson BM DPhil FRCP
Mandy Graves BA
Royal London Hospital
Massachusetts General Hospital
St Clement™s
50 Staniford Street 5th Floor
2A Bow Road
Boston MA 02114
London E3 4LL
Heinz Grunze MD
Dominique Eich MD Department of Psychiatry
Psychiatrische Universitatsklinik University of Freiburg

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