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35.4 Æ 11.4 31.8 Æ 11.3 31.1 Æ 11.6
Age at onset NS
n = 39 n = 40 n = 68
ATPD<BIP-MIXÃÃÃ
Disability 4 (10.3) 22 (35.7) 51 (65.4)
ATPD<BIP-NOMIXÃÃÃ
pension at
follow-up b BIP-MIX>BIP-NOMIXÃ
Premorbid n = 35 n = 34 n = 33
personality b
ATPD<BIP-MIXÃ
Obsessoid 8 (22.9) 16 (47.1) 20 (60.6)
ATPD<BIP-NOMIXÃÃ
Sthenic/highly 5 (14.3) 12 (35.3) 9 (27.3) NS
self-confident
ATPD>BIP-MIXÃÃ Ã
Asthenic/low 19 (54.3) 4 (11.8) 3 (9.1)
ATPD>BIP-NOMIXÃÃÃ
self-confident
Nervous-tense 3 (8.6) 2 (5.9) 1 (3.0) NS
Dimensional
n = 32 n = 15 n = 27
personality
scores (NEO-FFI) b
1.89 Æ 0.58 2.22 Æ 0.65 2.01 Æ 0.68
Neuroticism NS
2.06 Æ 0.52 1.98 Æ 0.50 1.87 Æ 0.51
Extroversion NS
2.17 Æ 0.38 2.08 Æ 0.44 2.33 Æ 0.48
Openness to NS
experiences
ATPD >BIP-MIXÃ c
2.73 Æ 0.43 2.39 Æ 0.41 2.53 Æ 0.42
Agreeableness
ATPD >BIP-MIXÃ d
2.76 Æ 0.44 2.31 Æ 0.71 2.43 Æ 0.50
Conscientiousness

a
Only pairwise comparisons with significant differences (2-test or Fisher™s exact test,
two-tailed) are shown. Ã P < 0.05; ÃÃ P < 0.01; ÃÃÃ P < 0.001; NS, no significance.
b
Reduced n, because some patients could not be followed up or information was insufficient to
rate this item.
232 A. Marneros et al.


Notes to Table 9.15 (cont.)

c
Differences overall significant in ANOVA (P = 0.035); pairwise comparisons given are
´
significant (P< 0.05) in Scheffe test.
d
Differences overall significant in ANOVA (P = 0.012); pairwise comparisons given are
´
significant (P < 0.05) in Scheffe test.
NEO-FFI, NEO Five-Factor Inventory; ANOVA, analysis of variance.



Conclusions
At the beginning of this chapter, we reported the opinion of Karl Kleist, who was
the main creator of cycloid disorders and also one of the most important antago-
nists of Emil Kraepelin. He wrote that many cases described by Emil Kraepelin as
mixed states could be better described as ˜˜cycloid psychoses.™™
Cycloid psychoses, according to Kleist, are bipolar disorders, but differ from
manic-depressive illness. After Kleist™s publications, the concept of cycloid dis-
orders created interest in psychiatrists outside Germany, such as Carlo Perris in
Sweden (Perris, 1986), Frank Fish (1964), Ian F. Brockington (Brockington et al.,
1982a, b) in the UK, and Mario Maj in Italy (1990) (see also Marneros and
Pillmann, 2004). Therefore, there is an international, but limited, acceptance of
cycloid psychoses. Nevertheless, the WHO integrated this concept in the category
of ATPD (F23) of ICD-10. In particular, one subgroup of ATPD, called ˜˜poly-
morphic psychotic disorder,™™ has considerable concordance with the concept of
cycloid disorders (Pillmann et al., 2001). In spite of some similarities between
ATPD and ˜˜classical™™ bipolar disorders, there are some differences. Patients with
ATPD are more frequently females, at their onset they have a better prognosis, and
they more frequently have an asthenic polymorphic personality than bipolar
patients. The comparison between ATPD and schizoaffective mixed states showed
that the prognosis of ATPD is much better than in schizoaffective mixed states,
and that females are significantly more frequently represented in the group of
ATPD. However, in spite of some similarities in phenomenology, there are also
differences between the two groups.
Our investigations showed that ATPD, especially the core group “ the poly-
morphic psychotic disorders and therefore also the so-called cycloid disorders “ are
not identical with manic-depressive illness. This is evident because the occurrence of
the full syndrome of mania or the full syndrome of major depression are exclusion
criteria. We have also shown further differences in other investigations (Marneros
et al., 2000, 2002, 2003; Pillmann et al., 2001, 2002a, b, 2003a; Marneros and
Pillmann, 2004). The longitudinal investigations support an interpretation that
locates the polymorphic psychotic disorders on a continuum between schizophrenia
233 Acute and transient psychotic disorder


and mood disorders, building together with the schizoaffective disorders the bridge
between the two classical types of major psychiatric disorders.


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