Chronic mania. Family history, prior course,
clinical picture and social consequences

Perugi G, Akiskal HS, Rossi L, Paiano A,
Quilici C, Madaro D, Musetti L, Cassano GB
Institute of Psychiatry, University of Pisa, Italy.
Br J Psychiatry 1998 Dec; 173:514-8


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.
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