Posted by Blue Cheer on March 22, 2000, at 9:24:56
In reply to Re: Me? Bipolar III citations for Sherry, posted by Noa on March 21, 2000, at 18:09:24
> Here is one citation. I gotta go--you can only use the internet at the library for 30 minutes if anyone is waiting.
> : Psychiatr Clin North Am 1999 Sep;22(3):517-34, vii
> Related Articles, Books, LinkOut
> The evolving bipolar spectrum. Prototypes I, II, III, and IV.
> Akiskal HS, Pinto O
> Department of Psychiatry, University of California at San Diego, La Jolla, USA.
> This article argues for the necessity of a partial return to Kraepelin's broad concept of
> manic-depressive illness, and proposes definitions--and provides prototypical cases--to illustrate
> the rich clinical phenomenology of bipolar subtypes I through IV. Although considerable evidence
> supports such extensions of bipolarity encroaching upon the territory of major depressive
> disorder, further research is needed in this area. From a practice standpoint, the compelling
> reason for broadening the bipolar spectrum lies in the utility of mood stabilizers as augmentation
> or monotherapy in the treatment of major depressive disorders with soft bipolar features falling
> short of the current strict standards for the diagnosis of bipolar II and hypomania in DSM-IV and
No psychopharmacologist is going to let vague descriptions of what does or doesn't constitute bipolar disorder affect his prescribing practice. Hagop Akiskal is in love with nosology and does a disservice to bipolars with his broad 'bipolar spectrum' concepts. Dr. Akiskal and others have been expanding the diagnostic boundaries and definitions of bipolar disorder since the 1970s. They see bipolarity everywhere; anyone who shows the slightest degree of affective instability -- from histrionic personality disorder to hyperactive children may find themselves under the nosological umbrella of bipolar spectrum. In 1981, Dr. G.L. Klerman concocted no less then 7 subtypes of BD. Although Kraepelin lumped together his 400 cases as being manic-depressive, his own data showed that over two-thirds of them suffered from recurrent depression and the other third were bipolar. This inclusiveness lasted until it became clear that lithium was a specific treatment for mania, and bipolar disorder became accepted as a discrete entity. Since the 1970s, the trend has been to expand the bipolar concept and further blurring the distinctions among affective disorders, while cheapening the classic concept of bipolar disorder. Why is this a problem? Bipolar disorder is about as close to a 'disease' as there exists in psychiatry, and the federal government has recently granted the largest mental health award ever to support the study of improved treatment of bipolar disorder. Some of these 'bipolar spectrum' disorders have resemblance in their symptoms and sometimes respond to drugs used in bipolar disorder; however, since the pathophysiological mechanisms involved in these disorders are unknown, then it's important to focus on well-defined diagnostic criteria to obtain similar patients for studies. In other words, the better defined the phenotype, the better the chances are to identify the underlying mechanisms. Given the serious attention and money being committed to the study of BD, this isn't the time to be diluting the concept.
Blue Cheer ~~~