Bipolar disorder: historic perspective, current pharmacologic treatment options and a review of quetiapine

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Date: Feb. 2006
From: Expert Review of Neurotherapeutics(Vol. 6, Issue 2)
Publisher: Expert Reviews Ltd.
Document Type: Article
Length: 10,081 words

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Author(s): Hani Raoul Khouzam [[dagger]] 1 , Fiza Singh 2


adverse effects; bipolar disorder; diagnosis; mania; pharmacology; treatment

Historic perspective

Bipolar disorder is one of the oldest known illnesses, with descriptions of its symptoms documented as far back as the second century. Aretaeus of Cappadocia (a city in ancient Turkey) was the first to recognize the symptoms of mania and depression and to link them, although his findings went largely unnoticed and unsubstantiated until 1621 when the scientist Richard Burton wrote 'The Anatomy of Melancholy', focusing specifically on depression [1,2] . Mainly as a consequence of this publication, Burton is credited as the father of depression, and his findings are still used by many in the mental health field today [1,3] .

Much later, in 1854, Jules Falret coined the term 'folie circulaire' (circular insanity) to describe a disorder characterized by episodes of depression and heightened moods that differed from simple depression. Falret recognized that the increased frequency of bipolar disorder in certain families pointed to a genetic link. Falret was also the first to recognize a link between depression and suicide. In 1875, his findings were termed 'manic-depressive psychosis'. Subsequently, this term was replaced by the more descriptive 'bipolar disorder' [4] .

Later, Francois Baillarger was instrumental in distinguishing bipolar disorder from schizophrenia, resulting in the classification of bipolar disorder as a separate entity with its own category of mental disorders [4] . In 1913, the German neuropsychiatrist, Emil Kraepelin, made detailed accounts of manic-depressive insanity, describing a continuum of mixed and rapid cycling subtypes. By the 1930s, Kraepelin's interpretation of the disorder became widely accepted. In 1952, an article by Kleist in The Journal of Nervous and Mental Diseases suggested a genetic basis for manic-depression due to its elevated prevalence in certain families [5] .

In the 1950s, and essentially for political reasons, Congress refused to recognize manic-depression as a legitimate illness, with the consequence that patients were denied public assistance and were frequently institutionalized. This lack of political initiative prevailed until the 1960s, when the American Psychiatric Association (APA) published the first edition of its 'Diagnostic and Statistical Manual of Mental Disorders' (DSM-I), in which a differentiation between major depression and manic-depressive illness was proposed [6] . The early 1970s saw the enactment of laws and standards providing social security benefits to patients with bipolar illness, culminating in 1979 in the foundation of the National Association of Mental Health (NAMI) [3] . In 1980, the third edition of the DSM (DSM-III) replaced the term 'manic-depressive disorder' with 'bipolar disorder' [7] . The fourth edition of the DSM, text revisions (DSM-IV-TR) expanded further on the definition of bipolar disorder, which was now classified as a heterogeneous group of mood disorders including bipolar I, bipolar II, mixed episodes and a separate diagnostic category of cyclothymic disorder [8] .

Symptoms & types of bipolar disorder

Several different subtypes of bipolar disorder have been described over the years, including the DSM-IV-TR categories of bipolar I disorder, bipolar II disorder and cyclothymic disorder.

In bipolar I disorder, the patient experiences one or...

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Gale Document Number: GALE|A224260833