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Re: Kraepelin and Study on BP Mixed States » Larry Hoover

Posted by Ron Hill on December 13, 2003, at 12:43:37

In reply to Re: about Kraepelin » Ron Hill, posted by Larry Hoover on December 13, 2003, at 12:19:01

Lar,

Looks like Kraepelin was ahead of his day. Thank you for digging up the Kraepelin information and the study.

-- Ron
---------------------

> Just because I think Kraepelin got it right a century ago, and we're still trying to get back there:
>
> "As many as one hundred years ago the physician Kraepelin suggested his theory of mixed mood states. He believed that they arose when mood, ideation, and psychomotor activity were incongruent. When all three were decreased, depression occurred; when all three were elevated the result was mania. If one of the domains was contradictory however, (for example, low mood with excitement and acceleration of activity), the diagnosis would be depressive mania. Kraepelin identified six different mixed states, in addition to the two pure states of mania and depression.
>
> Psychiatrists today recognize that there are more variations than Depressive Mania within the spectrum of mixed states, although the characteristics have not been defined, nor are these states official. Clinical experience has identified several different states that could be termed mixed states. These include Depressive Mania, Irritable Mania, Anxious Mania, Excited depression and Agitated Depression and others may exist. "
>
>
> Neuropsychopharmacology. 2001 Sep;25(3):373-83.
>
>
> Subtypes of mania determined by grade of membership analysis.
>
> Cassidy F, Pieper CF, Carroll BJ.
>
> Duke-Umstead Bipolar Disorders Program, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA. cassi002@mc.duke.edu
>
> Classical descriptions of mania subtypes extend back to Kraepelin; however, in marked contrast to the study of depression subtypes, validation of mania subtypes by multivariate statistical methods has seldom been attempted. We applied Grade of Membership (GOM) analysis to the rated clinical features of 327 inpatients with DSM-III-R mania diagnoses. GOM is a type of latent structure multivariate analysis, which differs from others of this type in making no a priori distributional assumptions about groupings. We obtained 5 GOM Pure Types with good face validity. The major Kraepelinian forms of "hypomania," "acute mania," "delusional mania," and "depressive or anxious mania" were validated. The major new finding is of two mixed mania presentations, each with marked lability of mood. The first of these displayed a dominant mood of severe depression with labile periods of pressured, irritable hostility and paranoia, and the complete absence of euphoria or humor. The second mixed mania Pure Type displayed a true, incongruous mixture of affects: periods of classical manic symptoms with euphoria, elation, humor, grandiosity, psychosis, and psychomotor activation, switching frequently to moderately depressed mood with pressured anxiety and irritability. This multivariate analysis validated classical clinical descriptions of the major subtypes of mania. Two distinct forms of mixed manic episodes were identified. DSM-III-R criteria did not reliably identify either of these two natural groups of mixed bipolar patients. As occurs in depression, this clinical heterogeneity of mania may influence response to drug treatments.
>


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poster:Ron Hill thread:286464
URL: http://www.dr-bob.org/babble/alter/20031204/msgs/289384.html