The poetics of bipolar disorder

2006 ◽  
Vol 14 (1) ◽  
pp. 83-110 ◽  
Author(s):  
James Goss

This article explores the role of affect in the disorganized language and thought that can manifest itself in bipolar disorder. Bipolar disorder, or as it was previously known, manic-depressive illness, can produce psychotic language and thought in its more extreme forms. During the production of discourse in bipolar disorder, there is a strong correlation between the underlying affective state, i.e., depression, euthymia, hypomania, and mania, and linguistic and cognitive performance. A psycholinguistic model of the dynamics between language, thought, and affect in bipolar disorder based on McNeill’s (1992, 2000) concept of a “Growth Point” is proposed. In particular, the poetic structural phases of discourse production in bipolar disorder, which vary according to the underlying affective state, provide a phenomenological bridge between the psychotic discourse of mania and normal language production.

1986 ◽  
Vol 149 (2) ◽  
pp. 191-201 ◽  
Author(s):  
Robert M. Post ◽  
David R. Rubinow ◽  
James C. Ballenger

Few biological theories of manic-depressive illness have focused on the longitudinal course of affective dysfunction and the mechanisms underlying its often recurrent and progressive course. The authors discuss two models for the development of progressive behavioural dysfunction—behavioural sensitisation and electrophysiological kindling—as they provide clues to important clinical and biological variables relevant to sensitisation in affective illness. The role of environmental context and conditioning in mediating behavioural and biochemical aspects of this sensitisation is emphasised. The sensitisation models provide a conceptual approach to previously inexplicable clinical phenomena in the longitudinal course of affective illness and may provide a bridge between psychoanalytic/psychosocial and neurobiological formulations of manic-depressive illness.


1992 ◽  
Vol 9 (1) ◽  
pp. 9-12 ◽  
Author(s):  
Patrick McKeon ◽  
Patrick Manley ◽  
Gregory Swanwick

AbstractThe treatment outcome of 100 bipolar disorder patients (B.P.) was examined retrospectively to determine whether bipolar subtypes had a differential prophylactic response to lithium, carbamazepine, neuroleptics and antidepressant drugs when these treatments were given in a predetermined sequence. Sixty-eight per cent of 53 B.P.-I patients with a mania-depression-normothymic-interval (M.D.I.) sequence of mood changes had a good response to lithium, and all but one of the remainder responded with the addition of carbamazepine or an antidepressant. While only 17% of 12 unipolar manic patients achieved prophylaxis with lithium and a further 17% when carbamazepine was added, the other 66% remained normothymic when a neuroleptic was prescribed with lithium. Of the seven rapid cycling patients where depression preceded mania, 28% had a good prophylactic effect with lithium, a further 28% when a tricyclic antidepressant was added and 14% with lithium and carbamazepine. None of the 18 rapid cycling M.D.I. group had a good response to lithium, but 39% stabilised when carbamazepine was added to lithium. Twenty-eight per cent of this group failed completely to respond to any of the treatments used. Neuroleptics increased the severity and duration of depressive phases for all subtypes except the unipolar mania group.


Author(s):  
Max Fink MD

Patients suffering from mania are overactive, intrusive, excited, and belligerent. They may believe that they have special powers, are related to public figures, and can read the minds of others. They spend money lavishly. Voices on the radio or television are sometimes understood as personal communications. They speak rapidly, with illogical and confused thoughts, move constantly, and write page after page of nonsense. They typically sleep and eat poorly, have little interest in work, friends, or family, and often require restraint or seclusion. Suicide is a perpetual threat. Some manic patients are likable, while others are angry and frightening. Psychosis is a frequent feature. Manic patients believe that their parents are not their real parents, asserting that they have royal blood. They believe that they can predict the future. They know that others are watching or talking about them, and they hear voices when no one is present. Delusional mania requires more intensive treatment and almost always hospital care. In older classifications of psychiatric illnesses, these patients were considered to be suffering from a manic-depressive illness. In modern classification, this term has been discarded and the illness is now conceived as bipolar disorder for patients with manic and depressive features and major depression for those with depressive symptoms only. Bipolar disorders, ranging from mild to severe, are divided into numerous subtypes. The variety of symptoms that admit the diagnosis of bipolar disorder has led to a virtual epidemic of diagnoses of the condition. Many patients so labeled do not exhibit the sleep difficulty, loss of appetite, and loss of weight, or the severity of illness, that were the criteria for manic-depressive illness. In manic-depressive illness, the manic episode persists for hours, days, weeks, or months and interferes with normal living. Once the episode resolves, it may suddenly recur; or manic episodes may alternate with periods of depression, or occur as simultaneous mixed episodes of depression and mania. When the shift in mood from mania to depression takes place within one or a few days, the condition is labeled rapid cycling, a particularly malignant form of the illness. In manic-depressive illness, the manic episode persists for hours, days, weeks, or months and interferes with normal living.


1994 ◽  
Vol 40 (2) ◽  
pp. 303-308 ◽  
Author(s):  
B J Carroll

Abstract Manic depressive illness (bipolar disorder) is the mood disorder classically considered to have a strong biological basis. During manic depressive cycles, patients show dramatic fluctuations of mood, energy, activity, information processing, and behaviors. Theories of brain function and mood disorders must deal with the case of bipolar disorder, not simply unipolar depression. Shifts in the nosologic concepts of how manic depression is related to other mood disorders are discussed in this overview, and the renewed adoption of the Kraepelinian "spectrum" concept is recommended. The variable clinical presentations of manic depressive illness are emphasized. New genetic mechanisms that must be considered as candidate factors in relation to this phenotypic heterogeneity are discussed. Finally, the correlation of clinical symptom clusters with brain systems is considered in the context of a three-component model of manic depression.


1978 ◽  
Vol 133 (5) ◽  
pp. 436-444 ◽  
Author(s):  
Julien Mendlewicz ◽  
Paul Verbanck ◽  
Paul Linkowski ◽  
Jean Wilmotte

SummaryGenetic factors play an important role in drug metabolism and drug response. In order to investigate genetic variables in lithium prophylaxis and lithium distribution across the erythrocyte in manic-depression, we have examined forty-two pairs of twins monozygotic (n = 25) and dizygotic (n = 17) with manic-depression. Concordant twins as a group show better lithium prophylaxis than do discordant twins. These results are consistent with previously published family studies of affective illness suggesting a positive relationship between genetic background and success of lithium prophylaxis.Lithium distribution across the red blood cell (RBC) was assessed by estimating lithium RBC/plasma ratios. The lithium ratio's intrapair differences in both groups of twins were minimal with a high heritability index suggesting that genetic factors play a role in lithium ion distribution. A high linear correlation was found between lithium ratio and plasma lithium and there was no difference in lithium ratios according to sex, affective state and response to lithium. The distribution of lithium ratios was homogenous in the lithium responders' population but this was not the case in the non-responders, suggesting biological heterogeneity of lithium distribution in lithium failures. The implications of these results are discussed as they relate to the genetic determinates of lithium prophylaxis in manic-depressive illness.These results indicate that lithium ratios are of limited value in lithium maintenance therapy. Our lithium kinetic data, however, are consistent with the concept of a lithium extrusion mechanism from red blood cells.


Author(s):  
Patricia Moran

This chapter discusses White’s illness within the context of medical and subjective accounts of bipolar disorder. It opens with a selective overview of White’s life that highlights the key sites of disruption and signs of illness. It then turns to an overview of manic-depressive illness, followed by a more detailed description of the characteristics of manic, depressive and mixed episodes. It ends with a brief comparison of White’s experiences of illness to those of her contemporary Virginia Woolf. This comparison demonstrates not only the diverse expressions of manic-depressive illness but also the different approaches that the writers themselves as well as family members adopted to cope with it.


Author(s):  
Paul Harrison ◽  
Philip Cowen ◽  
Tom Burns ◽  
Mina Fazel

‘Bipolar disorder’ provides an account of the clinical and scientific aspects of bipolar disorder (‘manic depressive illness’). Identification of varying degrees of mood elevation is critical to the diagnosis of bipolar disorder to allow its distinction from unipolar depression, and the phenomenology and classification of manic states is described in detail. The range of aetiological factors involved in the development of bipolar illness is covered, from genetics and brain structure to psychology and life events. The efficacy of treatments both psychological and pharmacological in bipolar disorder is assessed, including new approaches with psychoeducation, atypical antipsychotic drugs, and anticonvulsant mood stabilizers. An additional section covers the clinically challenging treatment of bipolar depression. The evidence from clinical trials is then placed in the context of good clinical management of both the acute phases of bipolar illness as well as longer-term maintenance treatment.


CNS Spectrums ◽  
2000 ◽  
Vol 5 (S1) ◽  
pp. 12-18 ◽  
Author(s):  
Frederick K. Goodwin ◽  
S. Nassir Ghaemi

AbstractWhich mood stabilizers are the most effective in reducing suicide rates in patients with bipolar disorder? This paper reviews the literature and compares the data on two types of mood-stabilizing agents, lithium and anticonvulsants. Compared with the large amount of data on lithium, there is surprising little information available on the effects of anticonvulsants on mortality in manic-depressive illness. Each was also assessed in terms of suicide risk factors such as depression and mixed episodes, rapid cycling, substance abuse, anxiety and panic, and central serotonergic function. Only two studies that provide data demonstrating anticonvulsant efficacy in preventing suicide in bipolar disorder are available, and the data are incomplete at best. Further research in this area should include an emphasis on the outcome of mortality in patients treated with any of the anticonvulsants or with lithium-anticonvulsant combinations.


1986 ◽  
Vol 15 (4) ◽  
pp. 365-369 ◽  
Author(s):  
Arthur Lazarus

A case of factitious disorder with physical symptoms is described in a patient with manic-depressive illness. The coexistence of factitious disorder and bipolar disorder has not been previously reported. Clinicians should search for an underlying affective disorder in patients who fabricate signs and symptoms of physical illness, since mania may simulate or contribute to the production of factitious behavior.


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