He coined the term manic depressive psychosis, after noting that periods of acute illness, manic or depressive, were generally punctuated by relatively symptom-free intervals where the patient was able to function normally. The first diagnostic distinction to be made between manic-depression involving psychotic states, and that which does not involve psychosis, came from Carl Gustav Jung in Jung illustrated the non-psychotic variation with 5 case histories, each involving hypomanic behaviour, occasional bouts of depression, and mixed mood states, which involved personal and interpersonal upheaval for each patient.
After World War II, John Cade, an Australian psychiatrist, was investigating the effects of various compounds on veteran patients with manic depressive psychosis. In , Cade discovered that lithium carbonate could be used as a successful treatment of manic depressive psychosis. In the s, U. Subclassification of bipolar disorder was first proposed by German psychiatrist Karl Leonhard in ; he was also the first to introduce the terms bipolar for those with mania and unipolar for those with depressive episodes only.
Measure content performance. Develop and improve products. List of Partners vendors. The phrase " manic depression " has its origins rooted in ancient Greece, where the term was used as early as the first century to describe symptoms of mental illness.
In her book Bipolar Expeditions: Mania and Depression in American Culture , author Emily Martin writes, "The Greeks believed that mental derangement could involve imbalance among the humors, as when melancholy, heated by the fluxes of the blood, became its opposite, mania. In the late s, Jean-Pierre Falret, a French psychiatrist, identified "folie circulaire," or circular insanity, manic and melancholic episodes that were separated by periods that were free of symptoms.
It is through his work that the term manic-depressive psychosis became the name of this psychiatric disorder. It's noteworthy that "psychosis" was included, thus excluding all types of what we know as bipolar disorder that do not include psychotic features. In , Emil Kraepelin organized and classified what used to be thought of as unitary psychosis into two categories. Manic-depression was the term he used to describe mental illnesses centered in emotional or mood problems.
Dementia praecox, literally meaning "premature madness," and later renamed schizophrenia , was his title for mental illnesses derived from thought or cognitive problems. In the early s, Karl Leonhard introduced the term bipolar to differentiate unipolar depression major depressive disorder from bipolar depression. In , with the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders DSM , the term manic depression was officially changed in the classification system to bipolar disorder.
In the last few decades, the medical profession, and psychiatry specifically, has made a concerted effort to shift the vernacular to the official DSM diagnostic term of bipolar disorder. There are a number of reasons cited for this shift, including:. There are three types of bipolar disorder recognized in DSM Dealing with racing thoughts? Always feeling tired? Our guide offers strategies to help you or your loved one live better with bipolar disorder.
It is also suggested that the low reported incidence of unipolar mania may be an artifact of clinical sampling rather than a true rarity, and highlights the importance of using symptom-specific diagnostics which cross the current diagnostic categories. Diagnostic criteria and prevalence rates for bipolar disorder in children and adolescents are controversial.
The ambiguity of this diagnosis in development has its roots in quandaries focused on to what extent bipolar disorder is a spectrum with a range of symptoms on the border of psychosis to normal behaviors, characterizing episodes of depression with fluctuations in mood that reliably identify periods of hypomania or mania, differentiating mood episodes from longstanding temperamental traits, differentiating primary symptoms from the effects of psychotropic medications or substances of abuse, developmental shifts in phenotypic symptom presentations, and differentiating mood disorders from other childhood disorders [ 37 ].
These diagnostic predicaments have been pondered for almost a century [ 37 , 38 , 39 ]. Nonspecific descriptions of children with putative mania date back to the 18th century [ 37 , 40 ]. In the s, two researchers attempted to unify the concept of manic depression.
This early description is congruent with the contemporary diagnostic construct of bipolar I [ 41 ]. Kraepelin also discussed the prospect of manic depression presenting in childhood [ 42 , 43 ].
Theodor Ziehen was a German physician who wrote prolifically on psychiatric disorders in childhood. Ziehen characterized childhood mania as a distinct entity on a spectrum with normal development, emphasized the recognition that manic symptoms represent a sudden shift from normal behavior, and commented on the potential inherent challenges in differentiating mania from normal development [ 44 ].
Interest in childhood manic-depression continued thereafter with systematic studies often characterizing postpubertal, depressive presentations [ 45 , 46 , 47 ]. Charles Bradley, widely considered the father of experimental child and adolescent psychopharmacology reportedly felt that mania was rare in children and discouraged use of the diagnostic construct in this population.
Of note, other early constructs of bipolar disorder were derived from psychoanalytic theory. Karl Abraham, Melanie Klein, and Adolf Meyer all commented on manic-depressive symptoms in childhood [ 37 , 43 ]. Abraham linked mania with oral stage but emphasized the contributions of physiologic and psychologic factors in symptom presentations [ 49 ]. Klein described a transient, manic-depressive, developmental phase as a part of childhood with hypomanic and manic defenses.
Current experts have also related that diagnostic criteria for manic-depression in children were likely underdeveloped initially as early, prominent psychoanalytic scholars felt that children lacked essential cognitive structures that materialize after pubertal psychosexual stages.
Early child psychoanalysts were also potentially treating a healthier population of patients as compared to hospitalized children [ 37 ]. Historically, descriptive criteria for bipolar disorder in children and adolescents trailed the development of adult criteria.
Two pages of DSM-II were devoted to this area and included broad constructs such as hyperkinetic reaction of childhood [ 9 ]. Weinberg and Brumback are often credited with developing modern, descriptive criteria for mania in children [ 43 ], and advocated for the adaptation of this concept despite the controversy.
Of note, patients in these early case reports were often characterized as hyperactive, among other constellations of symptoms [ 51 ]. These early efforts galvanized structured and semi-structured interviews as well as more symptom-driven approach for characterizing psychiatric illnesses in children and adolescents. Recently, DSM-5 brought pertinent changes in descriptive criteria for affective disorders [ 15 ].
Arguably these changes have elicited considerable controversy in the diagnosis and treatment of youth and for the first time in the history of DSM criteria, developmental perspectives have been given sustained consideration. Specifically, this includes the mixed features specifier that can be applied to a manic or depressive episode. This change has great utility for the diagnosis and treatment of children with mood disorders as mixed symptom presentations are common and concerning in children and adolescents [ 52 ].
Further, disruptive mood dysregulation disorder DMDD , a new depressive disorder diagnosis was introduced. A central, impairing diagnostic criteria for DMDD includes severe, long standing irritability punctuated by pathologic temper tantrums. The genesis of DMDD was driven by prior research efforts focused on severe mood dysregulation and concern over an accelerating, contemporary trend in which children and adolescents with noncyclical irritability have been diagnosed with bipolar disorder [ 53 ].
There has been considerable skepticism among clinicians and researchers regarding the DMDD diagnostic construct. Research suggests that youth with severe mood dysregulation vary from those with bipolar disorder with respect to family history [ 55 ], long-term outcomes [ 56 ], and neurobiology [ 57 ].
The DMDD diagnosis was modified slightly from severe mood dysregulation in that hyperarousal is not included, and if more than 1 day of hypomanic or manic symptoms are present, the DMDD diagnosis is not applied.
Opponents of the DMDD diagnostic construct maintain that empirical support for this dramatic change in criteria is lacking, and furthermore, no definitive information on the prevalence of DMDD currently exists.
In addition, the stability of the diagnosis is questionable in some reports. Existing information suggests that DMDD is highly comorbid with other mood and disruptive behavior disorders, thus also bringing it validity into question [ 53 ].
Studies of outpatient DMDD samples also indicate suboptimal reliability [ 58 ]. Psychosocial interventions, stimulant medications, mood stabilizers, antidepressants, and antipsychotics have been pondered as potential interventions. Detractors also have raised concerns that there are no effective, evidence based treatments for DMDD [ 59 , 60 ] and that clinical guidelines are based on extrapolation from other mood or disruptive behavioral disorders.
Presently, it is unclear if the DMDD diagnostic construct will have clinical utility, reduce the rate of bipolar diagnoses in childhood, or improve clinical outcomes for families [ 53 ]. Proponents of DMDD suggest that this construct allows clinicians to diagnosis and treat impairing symptoms in youth without imparting the idea that these patients will have a lifelong disease such as bipolar disorder.
Conversely, two large, nationally representative studies reveal high prevalence of bipolar disorders emerging in early adulthood 5. This suggests that a developmentally limited form of bipolar disorder exists and may resolve spontaneously, distinguishing it from a chronic, life-long version of the disorder [ 61 ].
In addition, a cross-sectional study of 10, adolescents 13—18 were examined for bipolar and MDD diagnoses. Data indicating that mania presented separately from depression suggest that the current understanding from which diagnostic criteria are drawn requires etiologic dissection and rethinking.
Using this RDoC approach, Nusslock et al. Asymmetrical alpha frequency across the frontal cortex as measured by EEG was explored as a physiological measure of approach motivation, with an increased relative signal indicating a propensity to approach and a reduced relative signal indicating reduced approach-related motivation, and correlated with mood and anxiety symptoms [ 63 ].
Using the RDoC framework to characterize discrete symptoms separate from diagnoses, these same physiological markers could distinguish mania present in bipolar disorder from the anhedonia component present in unipolar depression and were hypothesized to be helpful guides in characterizing anxiety and anger as additional symptoms or symptom clusters [ 63 ]. The RDoC approach has generated considerable controversy.
Proponents of the approach articulate that it was never intended to supplant diagnostic manuals such as DSM and ICD [ 64 ], but rather serve as a research approach that is agnostic to clinical diagnosis. Neuroscience-based treatment development for psychiatric disorders has stagnated over the last four decades, with molecular and neuroscientific research findings often not mapping onto clinical phenomenological approaches.
Recent work suggests this may be a particularly relevant approach for biomarker studies of bipolar disorder [ 21 ]. In the context of considering mood and bipolar spectrum constructs that are not congruent with traditional categorical, descriptive diagnoses used in clinical practice, these RDoC-influenced research approaches may have particular relevance.
However, at this point RDoC is not totally conducive to a clinical approach and thus neuroscience-based diagnostic categories will take many years to develop [ 65 ]. Though the extremes of mood known as mania and melancholia have been recognized since ancient time, the categorical diagnosis of bipolar disorder is a more modern concept.
Arguments pertaining to the validity of the current diagnostic framework include the push for a more spectrum-based approach in which more attention is paid to sub-syndromal or sub-threshold experiences of perturbed mood. It is hoped that exploration of the varied mood states experienced by those patients with bipolar disorder can lead us toward a categorization which provides the most clinically relevant evidence to guide effective treatments.
No grant funding was specifically utilized for the preparation of this review. Paul E. The content of this review is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Brittany L. Mason wrote this manuscript with contribution by Paul E. Croarkin and significant editorial input from E. Sherwood Brown. National Center for Biotechnology Information , U. Journal List Behav Sci Basel v. Behav Sci Basel. Published online Jul Mason , 1 E. Croarkin 2. Author information Article notes Copyright and License information Disclaimer. Received Apr 18; Accepted Jul 6. This article has been cited by other articles in PMC.
Abstract Mood is the changing expression of emotion and can be described as a spectrum. Keywords: bipolar disorder, manic depression, major depressive disorder, depression, mood disorder, diagnostic criteria, diagnostic and statistical manual of mental disorders, DSM, research domain criteria, history of bipolar disorder.
Introduction The overarching structure in which the changing expression of emotions is shaped is known as mood, and this long-term mood fluctuates over time [ 1 ]. Hippocrates: Melancholia and Mania These two extremes of mood have been documented in human history as early as ancient Greek physicians and philosophers, and were first systematically described by Hippocrates — BCE [ 3 ].
Falret and Baillarger: A Cycling Disease From antiquity through to the 19th century, mania and melancholia were considered to be two completely different disorders which embraced a wide variety of psychiatric syndromes. Kahlbaum and Kraepelin: A Comprehensive Description of Mood Dysfunction Early classification of the psychoses into a nosological framework was first put forth by Karl Kahlbaum , postulating a close correspondence between clinical symptoms, the disease course and outcome, brain pathology and etiology which suggested a natural disease entity [ 6 ].
Kraepelin, translated and quoted in [ 7 ]. DSM-5, There was some departure from the previous DSM in this edition that may satisfy some of the issues with the diagnostic criteria which are discussed later in this review.
Evaluating Diagnosis Nosology Modern biological research techniques, including neuroimaging and genetics, provide new insight into the causes of mental illness; however, they also add data to challenge the validity of the nosology of the psychoses and other psychiatric disease which are in current practice today. A Bipolar Spectrum The defining of two states of depression, unipolar in the absence of mania, and bipolar, in the presence of mania, has been criticized since its inception in DSM-III and some have desired to return to an earlier description of mood dysfunction [ 10 ].
Historical and Contemporary Conceptualization of Bipolar Disorder in Children and Adolescents Diagnostic criteria and prevalence rates for bipolar disorder in children and adolescents are controversial. Conclusions Though the extremes of mood known as mania and melancholia have been recognized since ancient time, the categorical diagnosis of bipolar disorder is a more modern concept.
Acknowledgments No grant funding was specifically utilized for the preparation of this review. Author Contributions Brittany L. Conflicts of Interest The authors declare no conflict of interest. References 1. Izard C. Basic emotions, relations among emotions, and emotion-cognition relations. Rosenberg E. Coherence between expressive and experiential system of emotions. Angst J. Bipolarity from ancient to modern times: Conception, birth and rebirth.
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