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Chronic mania. Family history, prior course, clinical picture and social consequences
G Perugi1, H S Akiskal, L Rossi
1Institute of Psychiatry, University of Pisa, Italy.
Background:
Mania with chronic course has been overlooked in the recent literature. Our aim was clinically to characterise and validate this form of mania.
Method:
We evaluated 155 people with DSM-III-R mania and assessed their family history, temperament, symptomatology and course. We used a semi-structured interview for mood disorders, as well as the Comprehensive Psychopathological Rating Scale and the Scale for the Assessment of Positive Symptoms.
Results:
Twenty (13%) had a chronic course arising from a background of hyperthymic temperament and recurrent mania, with a deteriorative pattern. Clinically, they were characterised by a significantly high rate of almost constant euphoria, grandiose delusions and related delusions, but had relatively low rates of sleep disturbance, psychomotor agitation and hypersexuality.
Conclusion:
Even with current therapies a significant number of people with bipolar disorders have a deteriorative outcome associated with the gradual disappearance of acute mania with an increase in megalomanic delusions, alienation from loved ones and decreased likelihood of medical and psychiatric care.