Introduction. Unipolar mania (UM) has received less than the expected attention, when compared to its contemporary mood disorders, unipolar depression (UD) and bipolar disorder (BD). Method. The literature search included PUBMED and PSYCINFO databases. Cross-searches of key references were made to identify other articles of importance. Results. There seems to be a bipolar subgroup with a stable, unipolar recurrent manic course. Although UM does not have significant differences from bipolar mania in terms of sociodemographic variables, there are certain significant differences in clinical features. UM is reported to have more grandiosity, psychotic symptoms, and premorbid hyperthymic temperament, but less rapid cycling, suicidality, seasonality, and comorbid anxiety disorders. It seems to have a better course of illness with better social and professional adjustment. However, its response to lithium prophylaxis is found to be poor as compared to classical BD and valproate could be a better choice in this case. Conclusion. The available literature suggests that UM has certain differences from classical BD. The evidence, however, is insufficient to categorize it as separate diagnostic entity. However, considering UM as a course specifier of BD would be a reasonable step. 1. Introduction: Unipolar Mania—Then and Now “Periodic mania” was the term which was first used by Kraepelin (1899) to refer to some of his cases having recurrent manic episodes without depression [1]. Wernicke (1900) proposed that single or recurrent episodes of mania or depression should be viewed as distinct disorders [2], separate from the ones which follow the continuous circular course of depression, mania, and free interval or “folie circulaire” as proposed by Falret [3]. “Phasic psychoses” were then classified by Kleist (1911, 1953) [4, 5] and Leonhard (1957) [6] who labeled pure mania and pure melancholia as “pure phasic psychoses” and manic-depressive psychosis as a “polymorphous phasic psychosis.” Genetic basis for distinction between unipolar mania and manic-depressive psychosis was first suggested by Neele (1949) [7]. The evolution of unipolar mania (UM) has continued since then, despite not receiving the distinct nosological status in the two most commonly used and accepted classificatory systems of DSM and ICD. It did not find any place even in the recently introduced DSM-5 [8]. In the chapter of bipolar and related disorders, DSM-5 has clearly stated that the lifetime experience of major depressive episode is not a requirement for diagnosing bipolar I disorder. This implies
References
[1]
E. Kraepelin, “Die klinische stellung der melancholie,” Monatsschrift für Psychiatrie und Neurologie, vol. 6, pp. 325–335, 1899.
[2]
C. Wernicke, Grundriss der Psychiatrie, Leipzig Thieme, 1900.
[3]
J. P. Falret, “De la folie circulaire ou forme de maladie mentale caracterisée par l'alternative reguliére de la manie et de la melancolie,” in Bulletin de l’Académie Nationale de Médecine, 1851.
[4]
K. Kleist, “Die klinische stellung der motilitatspsychosen,” Zeitschrift für die Gesamte Neurologie und Psychiatrie, vol. 3, pp. 914–977, 1911, Vortrag auf der versammlung des vereins bayerischer psychiater, Munchen, Germany, 1911.
[5]
K. Kleist, “Die gliederung der neuropsychischen erkrankungen,” Monatsschrift für Psychiatrie und Neurologie, vol. 125, pp. 526–554, 1953.
[6]
K. Leonhard, Aufteilung der endogenen psychosen und ihre differenzierte atiologie, Akademie, Berlin, Germany, 1957.
[7]
E. Neele, Die phasischen Psychosen nach ihrem Erscheinungs-und Erbbild, Johan Ambrosius Barth, Leipzig, Germany, 1949.
[8]
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, APA, Washington, DC, USA, 5th edition, 2013.
[9]
World Health Organization, The ICD-10 Classification of Mental and Behavioral Disorders, World Health Organization, Geneva, Switzerland, 1992.
[10]
C. Perris, “The distinction between bipolar and unipolar affective disorders,” in Handbook of Affective Disorders, E. S. Paykel, Ed., pp. 45–68, Churchill Livingstone, London, UK, 1982.
[11]
O. Dakhlaoui, I. Essafi, and F. Haffani, “Clinical particularism of bipolar disorder: unipolar mania. About a patients' study in Tunisia,” Encephale, vol. 34, no. 4, pp. 337–342, 2008.
[12]
C. Perris, “A study of bipolar (manic-depressive) and unipolar recurrent depressive psychoses,” Acta Psychiatrica Scandinavica, Supplement, vol. 194, pp. 1–89, 1966.
[13]
R. Abrams and M. A. Taylor, “Unipolar mania: a preliminary report,” Archives of General Psychiatry, vol. 30, no. 4, pp. 441–443, 1974.
[14]
R. Abrams, M. A. Taylor, M. A. Hayman, and N. Rama Krishna, “Unipolar mania revisited,” Journal of Affective Disorders, vol. 1, no. 1, pp. 59–68, 1979.
[15]
B. Pfohl, N. Vasquez, and H. Nasrallah, “Unipolar vs. bipolar mania: a review of 247 patients,” British Journal of Psychiatry, vol. 141, no. 5, pp. 453–458, 1982.
[16]
A. V. Rao, N. Hariharasubramanian, and S. P. Devi, “Lithium prophylaxis in affective disorder,” Indian Journal of Psychiatry, vol. 24, no. 1, pp. 22–30, 1982.
[17]
A. Venkoba Rao and T. Madhavan, “Depression and suicide behavior in the aged,” Indian Journal of Psychiatry, vol. 25, no. 4, pp. 251–259, 1983.
[18]
J. Nurnberger Jr., S. P. Roose, D. L. Dunner, and R. R. Fieve, “Unipolar mania: a distinct clinical entity?” American Journal of Psychiatry, vol. 136, no. 11, pp. 1420–1423, 1979.
[19]
K. Srinivasan, R. Ray, and P. S. Gopinath, “Unipolar mania—a separate entity?” Indian Journal of Psychiatry, vol. 27, pp. 321–324, 1982.
[20]
R. Khanna, N. Gupta, and S. Shanker, “Course of bipolar disorder in eastern India,” Journal of Affective Disorders, vol. 24, no. 1, pp. 35–41, 1992.
[21]
A. Avasthi, A. Sharma, N. Gupta, P. Kulhara, and V. K. Varma, “Seasonality and unipolar recurrent mania: preliminary findings from a retrospective study,” Indian Journal of Psychiatry, vol. 38, pp. 236–239, 1996.
[22]
H. S. Aghanwa, “Recurrent unipolar mania in a psychiatric hospital setting in the Fiji Islands,” Psychopathology, vol. 34, no. 6, pp. 312–317, 2001.
[23]
O. Yazici, K. Kora, A. ü？ok et al., “Unipolar mania: a distinct disorder?” Journal of Affective Disorders, vol. 71, no. 1–3, pp. 97–103, 2002.
[24]
M. Andrade-Nascimento, ？. Miranda-Scippa, F. Nery-Fernandes, F. Kapczinski, and L. C. Quarantini, “The identification of unipolar mania subtype based on anxiety comorbidity,” Journal of Affective Disorders, vol. 132, no. 3, pp. 356–359, 2011.
[25]
G. Perugi, M. C. S. Passino, C. Toni, I. Maremmani, and J. Angst, “Is unipolar mania a distinct subtype?” Comprehensive Psychiatry, vol. 48, no. 3, pp. 213–217, 2007.
[26]
R. O. A. Makanjuola, “Recurrent unipolar manic disorder in the Yoruba Nigerian: further evidence,” British Journal of Psychiatry, vol. 147, pp. 434–437, 1985.
[27]
K. I. Shulman and M. Tohen, “Unipolar mania reconsidered: evidence from an elderly cohort,” British Journal of Psychiatry, vol. 164, pp. 547–549, 1994.
[28]
A. Kubacki, “Male and female mania,” Canadian Journal of Psychiatry, vol. 31, no. 1, pp. 70–72, 1986.
[29]
P. K. Mittal, S. Mehta, R. K. Solanki, M. K. Swami, and P. S. Meena, “A Comparative study of seasonality and chronotype in unipolar mania vs bipolar affective disorder,” German Journal of Psychiatry, vol. 16, no. 4, pp. 124–129, 2013.
[30]
D. A. Solomon, A. C. Leon, J. Endicott et al., “Unipolar mania over the course of a 20-year follow-up study,” American Journal of Psychiatry, vol. 160, no. 11, pp. 2049–2051, 2003.
[31]
S. Lee and H. Yu, “Unipolar mania in non-Western cultures,” British Journal of Psychiatry, vol. 165, no. 3, p. 413, 1994.
[32]
S. Douki, F. Nacef, T. Triki, and J. Dalery, “Crosscultural aspects of bipolar disorder: results of a comparative study between French and Tunisian patients,” Encephale, vol. 38, pp. 194–200, 2012.
[33]
S. Mukherjee, D. B. Scnur, and R. Reddy, “Unipolar mania reconsidered: a CT scan study,” Biological Psychiatry, vol. 31, article 248A, 1992.
[34]
S. E. Starkstein, P. Fedoroff, M. L. Berthier, and R. G. Robinson, “Manic-depressive and pure manic states after brain lesions,” Biological Psychiatry, vol. 29, no. 2, pp. 149–158, 1991.
[35]
S. Cakir, Z. Akca, I. G. Seylam, and O. Yazici, “The role of depressive episodes in cognitive impairments of patients with bipolar disorder,” Bipolar Disorders, vol. 10, supplement 1, p. 41, 2008.
[36]
S. Lee, C. C. Chow, Y. K. Wing, and C. C. Shek, “Thyroid abnormalities during chronic lithium treatment in Hong Kong Chinese: a controlled study,” Journal of Affective Disorders, vol. 26, no. 3, pp. 173–178, 1992.
[37]
M. M. Husain, D. E. Meyer, M. H. Muttakin, and M. F. Weiner, “Maintenance ECT for treatment of recurrent mania,” American Journal of Psychiatry, vol. 150, no. 6, p. 985, 1993.
[38]
J. Angst, R. Gerber-Werder, H. U. Zuberbühler, and A. Gamma, “Is bipolar I disorder heterogeneous?” European Archives of Psychiatry and Clinical Neuroscience, vol. 254, pp. 82–91, 2004.
[39]
O. Yazici and S. Cakir, “Unipolar mania: a distinct entity or characteristic of manic preponderance?” Türk Psikiyatri Dergisi, vol. 23, pp. 201–205, 2012.
[40]
M. A. Margoob and K. S. Dutta, “A 15-years retrospective study of 50 patients of MDP for seasonal variations,” Indian Journal of Psychiatry, vol. 30, pp. 253–256, 1988.
[41]
O. Yazici, S. Cakir, and K. Kora, “Validity of unipolar mania diagnosis,” Bipolar Disorders, vol. 10, supplement 1, p. 66, 2008.
