Chapter
Family studies and genetics
Bipolar schizoaffective mixed states
Polymorphic psychotic disorders as a possible atypical bipolar disorder
Lessons from the past and options for the future
2 Emerging concepts of mixed states: a longitudinal perspective
Definition of bipolar mixed states
Toward a broader definition of mixed mania
Bipolar II and unipolar depressive mixed states
Long-term aspects of mixed states
3 Rapid-cycling bipolar disorder
Epidemiology, phenomenology, and comorbidity
Treatment recommendations
4 Bipolar I and bipolar II: a dichotomy?
Is there a true dichotomy between bipolar I and bipolar II disorder?
Clinical course and outcome
Family studies and genetics
5 Recurrent brief depression as an indicator of severe mood disorders
Recurrent brief psychiatric syndromes
Recurrent brief psychiatric syndromes
Rapid cycling and seasonality
Recurrent brief psychiatric syndromes and their overlap
The value of RBD, RBM, and hypomanic symptoms as a predictor of BP-II disorder
Combined versus pure mood disorders (Table 5.2)
Associations with other psychiatric disorders
What is the nature of RBD?
6 Atypical depression and its relation to bipolar spectrum
Introduction: the relationship of atypical depression to bipolar II disorder
Is AD more common in BP-II versus UP?
Is BP-II versus UP difference in AD frequency age-related?
Is there a difference in AD frequency in BP-II samples when probing for past hypomania focused on overactivity?
Is AD frequency still higher in BP-II versus UP when BP-II had a short hypomania?
Is AD a predictor of BP-II?
Can AD increase the probability of UP switching into hypomania?
Is there any difference in AD frequency in early-onset versus late-onset BP-II?
Is there any difference between BP-II AD and UP AD?
Is there a link between BP-II and UP AD?
What is the relationship between AD and age?
Are there differences between AD and non-AD?
Is there any difference between early-onset and late-onset AD?
What is the relationship between AD and chronic depression?
Are females more common in AD versus non-AD?
Is AD a moderate-severity depression?
Is there a link between depressive mixed state and AD?
Is there a link between female gender and AD in depressive mixed state?
Is psychomotor retardation more common in AD versus non-AD?
Is there a link between recurrences and AD?
What is the relationship between AD and psychotic features?
What is the relationship between AD and menopause?
The author's last sample study on atypical depression
7 Agitated depression: spontaneous and induced
Mixed affective states and agitated depression
The parallelism between drive, mood, and thought
Clinical picture of agitated depression
Clinical forms of agitated depression
Psychotic agitated depression
Agitated depression (non-psychotic) with psychomotor agitation
Minor agitated depression
Flight of ideas, racing and crowded thoughts
Restlessness, inner agitation, and anxiety
The nature and definition of agitated depression
Diagnostic criteria of agitated depression
Spontaneous and induced agitated depression
Latent agitated depression
Treatment with olanzapine
Agitated depression followed by simple depression
8 Schizoaffective mixed states
Developments of the definition of schizoaffective disorders
Current research in schizoaffective mixed states
Schizoaffective mixed states in the Cologne study
The Halle Bipolarity Longitudinal Study
Characteristics of episodes
Frequency of patients having mixed episodes
Initial episode and first manifestation of a mixed episode
9 Acute and transient psychotic disorder: an atypical bipolar disorder?
Definitions of acute and transient psychotic disorders
The predecessors of the acute and transient psychotic disorders
What are acute and transient psychotic disorders?
ATPD versus bipolar affective mixed states versus bipolar schizoaffective mixed states
Polymorphic subgroup of ATPD versus bipolar affective mixed versus bipolar schizoaffective mixed states
ATPD versus all mixed states (affective plus schizoaffective)
Polymorphic subgroup versus all mixed (affective and schizoaffective)
ATPD versus the groups of bipolar affective mixed, bipolar schizoaffective mixed, bipolar affective non-mixed, and non-mixed bipolar schizoaffective disorders
10 Bipolar disorder in children and adolescents
11 Atypical features of bipolarity in old age
Age of onset and clinical course
Atypical treatment issues
12 Comorbidity in mixed states and rapid-cycling forms of bipolar disorders
Medical conditions and neuropsychiatric disorders
Substance-abuse disorders
Other psychiatric disorders
The general effect of comorbidity
13 Challenges in the genetics of bipolar disorder
Epidemiology of mood disorders
Genetic epidemiology of mood disorders in adults
Review of empirical evidence
Factors associated with familial transmission of mood disorders
Relationship to the proband
Twin studies of mood disorders
Adoption studies of the mood disorders
Genetic epidemiology of mood disorders in youth
Genetic marker studies of mood disorders
Association studies of mood disorders
Review of empirical evidence
Linkage studies of mood disorders
Review of empirical evidence
Challenges to the identification of genes for mood disorders
Psychiatric disorder phenotypes
Lack of direct correspondence between the genotype and phenotype
Gene–environment interaction
14 Biological aspects of rapid cycling and mixed states
Implications of catecholamines on mixed states and rapid cycling
Implications of hormonal aberrations on mixed states and rapid cycling
The impact of transmembranous ion fluxes on rapid cycling and mixed states
How do antiepileptic drugs used in treating mixed states and rapid cycling potentially interfere with intracellular calcium signalling?
Other mechanisms of mood stabilizers possibly related to rapid cycling and mixed states
15 The treatment of bipolar mixed states
Mixture of elements (mood, activity, thinking)
Depression as characterological response to mania
Manic defense in depression
Transition state during a cycle: MDI/DMI
Mixed states in predominantly depressed bipolar patients (BP-II, Dm)
Modified by substance misuse
Modified by organic brain disease
With mood-incongruent psychotic features
Schizoaffective mixed states
Clinical trials in mania and mixed states
Treatment responses in different models of mixed states
Cortisol levels during response to antipsychotics
Antipsychotics, depression in mania, and switch into depression
"Manic defense," transitions, and treatment of mania
Antipsychotics in prophylaxis of bipolar disorder
Treatment of mixed states with antidepressants
Antidepressants in bipolar mixed states
Resistance to treatment in mixed states
Combining lithium and antidepressants in prophylaxis of mixed mania
16 The use of atypical antipsychotic agents in the treatment of diagnostic subgroups of bipolar disorder: mixed and pure states, psychotic and non-psychotic
Controlled studies of atypical antipsychotic medications in bipolar disorder
Use of atypical antipsychotic medications in mania: psychotic and non-psychotic patients
17 Investigational strategies: treatment of rapid cycling, mixed episodes, and atypical bipolar mood disorder
Difficulties in conducting clinical trials for atypical bipolar disorder
Difficulties in conducting clinical trials for mixed episodes
Difficulties in conducting clinical trials for rapid cycling
What are the lessons from clinical trials for rapid cycling?
Rapid cycling: clinical trial design issues
Bipolar Disorders
：Mixed States, Rapid Cycling and Atypical Forms
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