Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-24T07:15:36.515Z Has data issue: false hasContentIssue false
  • English
  • Français

Bipolar Affective Disorder: Causes and Prevention of Relapse

Published online by Cambridge University Press:  02 January 2018

Trevor Silverstone  and
Sarah Romans-Clarkson
Trevor Silverstone*
Affiliation:
Medical College of St Bartholomew's Hospital, West Smithfield, London EC1
Sarah Romans-Clarkson
Affiliation:
Department of Psychological Medicine, University of Otago Medical School, Dunedin, New Zealand
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

Abstract

The majority of patients with bipolar affective disorder relapse at least once during their lifetime, most several times, often with disastrous consequences. In this review we examine those factors which appear to play a facilitatory and in some cases, a causal role in determining whether a relapse will occur and, if so, when. Such factors include: the season of the year, with most admissions for mania in the British Isles occurring in the summer months; change in endocrine status, as after childbirth or when there is impaired thyroid function; treatment with drugs affecting central monoamine, particularly dopamine, neurotransmission; untoward life events. We evaluate the relative efficacy of treatments for the prevention of relapse, such as lithium, carbamazepine and antipsychotics, in the context of social and psychological support systems.

Type
Review Articles
Information
The British Journal of Psychiatry , Volume 154 , Issue 3 , March 1989 , pp. 321 - 335
Copyright
Copyright © Royal College of Psychiatrists, 1989 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abou-Saleh, M. T. (1982) Mania associated with weaning: a hypothesis. British Journal of Psychiatry, 140, 547–548.Google Scholar
Abou-Saleh, M. T. & Coppen, A. (1986) Who responds to prophylactic lithium? Journal of Affective Disorders, 10, 115–125.Google Scholar
Abrams, R. & Taylor, M. A. (1974) Unipolar mania. Archives of General Psychiatry, 30, 441–443.Google Scholar
Abrams, R., Taylor, M. A., Hayman, M. A., et al (1979) Unipolar mania revisited. Journal of Affective Disorders, 1, 59–68.CrossRefGoogle ScholarPubMed
Ahlfors, U. G., Basstrup, P. C., Dencker, S. J., et al (1981) Flupenthixol decoanate in recurrent manic depressive illness. Acta Psychiatrica Scandinavica, 64, 226–237.CrossRefGoogle ScholarPubMed
Ambelas, A. (1979) Psychological stressful events in the precipitation of manic episodes. British Journal of Psychiatry, 135, 15–21.CrossRefGoogle ScholarPubMed
Ambelas, A. (1987) Life events and mania: a special relationship? British Journal of Psychiatry, 150, 235–240.Google Scholar
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington, DC: APA.Google Scholar
Angst, J. (1981) Course of affective disorders. In Handbook of Biological Psychiatry (ed. Van Praag, H.), pp. 225–242. New York: Marceli Dekker.Google Scholar
Angst, J. (1985) Switch from depression to mania – a recorded study over decades between 1920 and 1982. Pyschopathology, 18, 140–154.Google Scholar
Angst, J., Grof, P., Hippius, H. et al (1968) La psychose maniaco-depressive est-elle periodique ou intermittente? In Cycles Biologiques et Psychiatrie (ed. de Ajuriaguerra, H.), pp. 339–351. Geneva; Georg et cie.Google Scholar
Angst, J. & Clayton, P. (1986) Premorbid personality of depressive, bipolar and schizophrenic patients with special reference to suicidal issues. Comprehensive Psychiatry, 27, 511–532.Google Scholar
Aronson, T. A. & Shukla, S. (1987) Life events and relapse in bipolar disorder: the impact of a catastrophic event. Acta Psychiatrica Scandinavica, 75, 571–576.Google Scholar
Astrup, C., Fossum, A. & Holmboe, R. (1959) A follow-up study of 270 patients with acute affective psychoses. Acta Psychiatrica Scandinavica, 34 (suppl. 135), 1–65.Google Scholar
Baastrup, P. C., Poulsen, J. C., Schou, M., et al (1970) Prophylactic lithium: double-blind discontinuation in manic-depressive disorders. Lancet, ii, 326–330.Google Scholar
Ballenger, J. C., & Post, R. M. (1980) Carbamazepine in manic-depressive illness: a new treatment. American Journal of Psychiatry, 137, 782–790.Google ScholarPubMed
Bech, P., Vendsborg, P. B., & Rafaelson, O. J. (1976) Lithium maintenace treatment of manic melancholic patients: its role in the daily routine. Acta Psychiatrica Scandinavica, 53, 70–81.Google Scholar
Benson, R. (1976) Psychological stress as a cause of lithium prophylaxis failure: a report of three cases. Diseases of the Nervous System, 37, 699–700.Google Scholar
Bidzinksa, E. J. (1984) Stress factors in affective diseases. British Journal of Psychiatry, 144, 161–166.Google Scholar
Black, D. W., Winokur, G. & Nasrallah, A. (1987) Suicide in subtypes of major affective disorder. Archives of General Psychiatry, 44, 878–880.Google Scholar
Bland, R. C. & Orn, H. (1982) Course and outcome in affective disorders. Canadian Journal of Psychiatry, 27, 573–578.Google Scholar
Boyd, J. H. & Weissman, M. M. (1982) Epidemiology. In Handbook of Affective Disorders (ed. Paykel, E. S.), pp. 109–125. Edinburgh: Churchill Livingstone.Google Scholar
Bratfos, D. & Haug, J. D. (1968) The course of manic-depressive psychosis. Acta Psychiatrica Scandinavica, 44, 89–112.CrossRefGoogle ScholarPubMed
Brown, G. W., & Harris, T. (1978) Social Origins of Depression. London: Tavistock Publications.Google Scholar
Bunney, W. E. (1978) Psychopharmacology of the switch process in affective disorders. In Psychopharmacology: A Generation of Progress (eds Lipton, M. A., Marcio, A. D., Killam, K. F.), pp. 1249–1259. New York, Raven Press.Google Scholar
Bunney, W. E. & Gurland-Bunney, B. L. (1987) Mechanisms of action of lithium in affective illness. In Psychopharmacology: A Third Generation of Progress (ed. Meltzer, H. Y.), pp. 553–565. New York: Raven Press.Google Scholar
Carlson, G. A., Kotin, J., Davenport, Y. B., et al (1974) Follow-up of 53 bipolar manic-depressive patients. British Journal of Psychiatry, 124, 134–139.Google Scholar
Carlsson, A., Svennerholm, L., & Winblad, B. (1980) Seasonal and circadian monoamine variations in human brain examined post-mortem. Acta Psychiatrica Scandinavica, 61 (suppl. 280), 75–83.CrossRefGoogle ScholarPubMed
Carney, A. (1989) Influence of climate on the prevalence of mania. In Seasonal Affective Disorders (eds Thompson, C. & Silverstone, T.). London: CNS Publications (in press).Google Scholar
Carrol, B. J. (1979) Prediction of treatment outcome with lithium. Archives of General Psychiatry, 36, 870–878.Google Scholar
Checkley, S. A. (1978) Thyrotoxicosis and the course of manic-depressive illness. British Journal of Psychiatry, 133, 219–233.Google Scholar
Cho, J. T., Bone, S. & Dunner, D. L. (1979) The effect of lithium treatment on thyroid function in patients with primary affective disorder. American Journal of Psychiatry, 136, 115–116.Google ScholarPubMed
Chouinard, G., Young, S. N. & Annable, L. (1983) Antimanic effect of clonazepam. Biological Psychiatry, 18, 451–466.Google ScholarPubMed
Chung, R. K., Langeluddecke, P. & Tennant, C. (1986) Threatening life events in the onset of schizophrenia, schizophreniform psychosis and hypomania. British Journal of Psychiatry, 148, 680–685.Google Scholar
Cohen, B. M., Lipinski, J. F. & Altesman, R. I. (1982) Lecithin in the treatment of mania. American Journal of Psychiatry, 139, 1162–1164.Google ScholarPubMed
Cookson, J. C. (1981) Oestrogens, dopamine and mood. British Journal of Psychiatry, 139, 365–366.Google Scholar
Cookson, J. C. (1982) Post-partum mania, dopamine and oestrogens. Lancet, ii, 672.Google Scholar
Cookson, J. C. (1985) The neuroendocrinology of mania. Journal of Affective Disorders, 8, 233–241.CrossRefGoogle ScholarPubMed
Cookson, J. C. & Silverstone, T. (1976) 5-hydroxytryptamine and dopamine pathways in mania: a pilot study of fenfluramine and pimozide. British Journal of Clinical Pharmacology, 3, 942–943.Google Scholar
Cookson, J. C., Silverstone, T. & Wells, B. (1981) A double-blind comparative clinical trial of pimozide and chlorpromazine in mania – a test of the dopamine hypothesis. Acta Psychiatrica Scandinavica, 64, 381–397.CrossRefGoogle Scholar
Coppen, A., Noguera, R., Bailey, J., et al (1971) Prophylactic lithium in affective disorders. Lancet, ii, 275–279.CrossRefGoogle Scholar
Coppen, A., Montgomery, S. A., Gupta, R. K., et al (1976) Decreasing lithium dosage reduces morbidity and side-effects during prophylaxis. Journal of Affective Disorders, 6, 353–362.Google Scholar
Corn, T. H. & Checkley, S. A. (1983) A case of recurrent mania with recurrent hyperthyroidism. British Journal of Psychiatry, 143, 74–76.Google Scholar
Coryell, W., Andreasen, N., Endicott, J., et al (1987) The significance of past mania or hypomania in the course and outcome of major depression. American Journal of Psychiatry, 144, 309–315.Google ScholarPubMed
Cowdry, R. W., Wehr, T. A., Zis, A. P., et al (1983) Thyroid abnormalities associated with rapid cycling bipolar illness. Archives of General Psychiatry, 40, 414–420.Google Scholar
Cutler, N. R. & Post, R. M. (1982) Life course of illness in untreated manic depressive patients. Comprehensive Psychiatry, 23, 101–108.Google Scholar
Davis, K. L., Berger, P. A., Hollister, L. E., et al (1978) Physostigmine in mania. Archives of General Psychiatry, 35, 119–122.Google Scholar
Dean, C. & Kendell, R. E. (1981) The symptomatology of puerperal illness. British Journal of Psychiatry, 139, 128–133.Google Scholar
Dickson, W. E. & Kendell, R. E. (1986) Does maintenance lithium prevent recurrences of mania under ordinary clinical conditions? Psychological Medicine, 16, 521–530.CrossRefGoogle ScholarPubMed
Dietzel, M., Saletu, B., Lesch, O. M., et al (1986) Light treatment in depressive illness. Polysomnographic, psychometric and neuroendocrine findings. European Neurology, 25 (suppl. 2), 93–103.Google Scholar
Dilsaver, S. C., Greden, J. F. & Snider, R. M. (1987) Antidepressant withdrawal syndromes: phenomenology and pathophysiology. International Clinical Psychopharmacology, 2, 1–19.Google Scholar
Di Paola, T., Poyet, P. & Labrie, F. (1981) Effects of chronic oestradiol and haloperidol treatment on striated dopamine receptors. Journal of Pharmacology, 73, 105–106.Google Scholar
Di Paola, T., Fleiss, J. L. & Fieve, R. R. (1976) Lithium carbonate prophylaxis failure. British Journal of Psychiatry, 129, 40–44.Google Scholar
Di Paola, T., Fleiss, J. L. & Fieve, R. R. (1977) Rapid cycling manic depressive illness. Comprehensive Psychiatry, 18, 561–566.Google Scholar
Di Paola, T., Fleiss, J. L. & Fieve, R. R. (1979) Life events at the onset of bipolar affective illness. American Journal of Psychiatry, 136, 508–511.Google Scholar
Durkheim, E. (1897) Le Suicide: étude de sociologie. Paris: Alcan.Google Scholar
Eastwood, M. R. & Stiasny, S. (1978) Psychiatric disorder, hospital admission and season. Archives of General Psychiatry, 35, 769–771.Google Scholar
Egeland, J. A., Gerhard, D. S., Pauls, D. L., et al (1987) Bipolar affective disorder linked to DNA markers on chromosome 11. Nature, 325, 783–787.Google Scholar
Emrich, H. M., Dose, M. & Von Zerssen, D. (1985) The use of sodium valporate carbamazepine and oxycarbamazepine in patients with affective disorders. Journal of Affective Disorders, 8, 243–250.Google Scholar
Esparon, J., Kolloori, J., Naylor, G. J., et al (1986) Comparison of the prophylactic action of flupenthixol with placebo in lithium-treated manic-depressive patients. British Journal of Psychiatry, 148, 723–725.Google Scholar
Esquirol, J. E. D. (1845) Des Maladies Mentales (trans. Hunt, E. K.). Philadelphia: Lea and Blanchard.Google Scholar
Extein, I., Pottash, A. L. C. & Gold, M. S. (1982) Does subclinical hypothyroidism predispose to tricyclic-induced rapid mood cycles? Journal of Clinical Psychiatry, 43, 290–291.Google ScholarPubMed
Fadden, G., Bebbington, P. & Kuipors, L. (1987) Caring and its burdens: a study of spouses of depressed patients. British Journal of Psychiatry, 151, 660–667.Google Scholar
Fleiss, J. L., Prien, R., Dunner, D. L., et al (1978) Actuarial studies of the course of manic depressive illness. Comprehensive Psychiatry, 19, 355–362.Google Scholar
Folks, D. G., King, D. L. & Dowdy, S. B. (1982) Carbamazepine treatment of selected affectively disordered patients. American Journal of Psychiatry, 139, 115–117.Google Scholar
Folstein, M. F., de Paulo, J. R. & Trepp, K. (1982) Unusual mood stability in patients taking lithium. British Journal of Psychiatry, 140, 188–191.Google Scholar
Forrest, A. D., Fraser, R. H. & Priest, R. G. (1965) Environmental factors in depressive illness. British Journal of Psychiatry, 111, 243–253.Google Scholar
Frangos, A., Athanassenas, G., Tsitourides, S., et al (1980) Seasonality of the episodes of recurrent affective psychoses: possible prophylactic interventions. Journal of Affective Disorders, 2, 239–247.Google Scholar
Garattini, S., Menini, T. & Bendotti, C. (1986) Neurochemical mechanism of action of drugs which modify feeding via the serotenergic system. Appetite, 7 (suppl.): 15–38.Google Scholar
Gerner, R. H., Post, R. M. & Bunney, W. E. (1976) A dopaminergic mechanism in mania. American Journal of Psychiatry, 133, 1177–1180.Google Scholar
Glassner, B., Haldipur, C. V. & Dessaversmith, J. J. (1979) Role loss and working-class manic-depression. Journal of Nervous and Mental Diseases, 167, 530–541.Google Scholar
Glassner, B. & Haldipur, C. V. (1983) Life events and early and late onset of bipolar disorder. American Journal of Psychiatry, 140, 215–217.Google Scholar
Gold, P. W. & Rubinow, D. R. (1987) Neuropeptide function in affective illness. In Psychopharmacology: The Third Generation of Progress (ed. Meltzer, H. T.), pp. 617–627. New York: Raven Press.Google Scholar
Goodnick, P. J., Fieve, R. R. & Schlegel, A. (1987) Clinical and chemical effects of lithium discontinuation. American Journal of Psychiatry, 144, 385.Google Scholar
Goodnick, P. J., Fieve, R. R., Schlegel, A., et al (1987) Prediction of interepisode symptoms and relapse in affective disorder patients treated with lithium carbonate. American Journal of Psychiatry, 144, 367–369.Google Scholar
Goodwin, F. K. & Jamison, K. R. (1984) The natural course of manic–depressive illness. In Neurobiology of Mood Disorders (eds Post, R. M. & Ballenger, J. C.), pp. 20–38. Baltimore: Williams & Wilkins.Google Scholar
Haag, H., Heidorn, A., Greil, W., et al (1986) Sequence of affective polarity and response to stabilising lithium therapy. Comprehensive Psychiatry, 18, 497–502.Google Scholar
Hall, K. S. (1984) A prospective study of life events and affective episodes in a population of manic depressive patients. PhD thesis, Columbia University.Google Scholar
Hall, K. S., Dunner, D. L., Zeller, G., et al (1977) Bipolar illness: a prospective study of life events. Comprehensive Psychiatry, 18, 497–502.Google Scholar
Hardy, M. C., Lecrubier, Y. & Widlocher, D. (1986) Efficacy of Clonidine in 24 patients with acute mania. American Journal of Psychiatry, 143, 1450–1453.Google Scholar
Hare, E. & Walter, S. D. (1978) Seasonal variation in admissions of psychiatric patients and its relation to seasonal variation in their birth. Journal of Epidemiology and Community Health, 32, 47–52.Google Scholar
Hippocrates (1938) On Airs, Waters and Places. Medical Classics, Vol. 3. Baltimore: Williams & Wilkins.Google Scholar
Hirschfeld, R. M. A., Klerman, G. L., Keller, M. B., et al (1986) Personality of recovered patients with bipolar affective disorder. Journal of Affective Disorders, 11, 81–89.Google Scholar
Hodgkinson, S., Sherrington, R., Gurling, H., et al (1987) Molecular genetic evidence for heterogeneity in manic depression. Nature, 325, 805–806.CrossRefGoogle ScholarPubMed
Hollender, M. H. & Goldin, M. L. (1978) Single case study: funeral mania. Journal of Nervous and Mental Disease, 166, 890–892.Google Scholar
Horesh, N., Lepkitker, E., Milgram, N., et al (1987) Presented at International Conference on New Directions in Affective Disorders, Jerusalem.Google Scholar
Isaacs, G. & Thompson, C. (1988) Phototherapy and its mechanism of action. Journal of Affective Disorders, 14, 13–20.Google Scholar
James, N. & Chapman, C. J. (1975) A genetic study of bipolar affective disorder. British Journal of Psychiatry, 126, 449–456.Google Scholar
James, S. P., Wehr, T. A., Sack, D. A., et al (1985) Treatment of seasonal affective disorder with light in the evening. British Journal of Psychiatry, 147, 442–448.Google Scholar
Jamison, K. R., Gerner, R. H. & Goodwin, J. K. (1979) Patient and physician attitudes towards lithium: relation to compliance. Archives of General Psychiatry, 36, 866–869.CrossRefGoogle Scholar
Jamison, K. R. & Akiskal, H. S. (1983) Medication compliance in patients with bipolar disorder. Psychiatric Clinics of North America, 6, 175–192.Google Scholar
Janowsky, D. S., El Yousef, M. K. & Davis, J. M. (1973) Parasympathetic suppression of manic symptoms by physostigmine. Archives of General Psychiatry, 28, 542–547.Google Scholar
Jauhar, P. & Weller, M. P. I. (1982) Psychiatric morbidity and time zone changes: a studTy of patients from Heathrow Airport. British Journal of Psychiatry, 140, 231–235.Google Scholar
Jenner, F. A., Goodwin, J. C., Sheridan, M., et al (1968) The effect of an altered time regime on biological rhythms in a 48 hour periodic psychosis. British Journal of Psychiatry, 114, 215–224.Google Scholar
Jimerson, D. C. (1987) Role of dopamine mechanisms in the affective disorders. In Psychopharmacology: The Third Generation of Progress (ed. Meltzer, H. Y.), pp. 505–511. New York: Raven Press.Google Scholar
Jones, B. D., Steinberg, S. & Chouinard, G. (1984) Fast-cycling bipolar disorder induced by withdrawal from long-term treatment with a tricyclic antidepressant. American Journal of Psychiatry, 141, 108–109.Google Scholar
Josephson, A. M. & Mackenzie, T. B. (1979) Appearance of manic psychosis following rapid normalization of the thyroid status. American Journal of Psychiatry, 136, 846–847.Google ScholarPubMed
Josephson, A. M. & Mackenzie, T. B. (1980) Thyroid induced mania in hypothyroid patients. British Journal of Psychiatry, 137, 222–228.Google Scholar
Joyce, P. R. (1984) Parental bonding in bipolar affective disorder. Journal of Affective Disorders, 7, 319–324.Google Scholar
Joyce, P. R. (1985) Illness behaviour and rehospitalisation in bipolar affective disorder. Psychological Medicine, 15, 521–525.CrossRefGoogle Scholar
Joyce, P. R., Rogers, J. R. M. & Anderson, E. D. (1981) Mania associated with weaning. British Journal of Psychiatry, 139, 355–356.Google Scholar
Kadrmas, A., Winokur, G. & Crow, R. (1979) Post-partum mania. British Journal of Psychiatry, 135, 551–554.CrossRefGoogle Scholar
Katona, C. L. E. (1982) Puerperal mental illness: a comparison with non-puerperal controls. British Journal of Psychiatry, 141, 447–452.Google Scholar
Kennedy, S., Thompson, R., Stancer, H. C., et al (1983) Life events precipitating mania. British Journal of Psychiatry, 142, 358–403.Google Scholar
Kocsis, J. H. & Stokes, P. E. (1979) Lithium maintenance: factors affecting outcome. American Journal of Psychiatry, 136, 563–566.Google Scholar
Kraepelin, E. (1921) Manic-depressive Insanity and Paranoia (trans Barclay, R. M.). Edinburgh: E. & S. Livingstone.Google Scholar
Krauthammer, C., & Klerman, G. (1978) Secondary mania. Manic syndromes associated with antecedent physical illness or drugs. Archives of General Psychiatry, 35, 1333–1339.Google Scholar
Kukopulos, A. & Reginaldi, D. (1980) Recurrences of manic-depressive episodes during lithium treatment. Handbook of Lithium Therapy (ed. Johnson, F. N.), pp. 109–117. Lancaster: MTP.Google Scholar
Kukopulos, A., Reginaldi, D., Laddomada, P., et al (1980) Course of manic-depressive cycle and changes caused by treatments. Pharmakopsychiatry, 13, 156–157.Google Scholar
Lazarus, J. H., John, R., Bennie, E. H., et al (1981) Lithium therapy and thyroid function: a long-term study. Psychological Medicine, 11, 85–92.Google Scholar
Lazarus, J. H., McGregor, A. M., Ludgate, M., et al (1986) Effect of lithium carbonate therapy on thyroid immune status in manic-depressive patients: a prospective study. Journal of Affective Disorders, 11, 155–160.Google Scholar
Leff, J., Fischer, M. & Bertelsen, A. C. (1976) A cross national epidemiological study of mania. British Journal of Psychiatry, 129, 428–442.Google Scholar
Leonhard, K. (1959) Aufeiling der Endogenen Psychosen (2nd edn). Berlin.Google Scholar
Lewy, A. J., Wehr, T. A., Goodwin, F. K., et al (1981) Manic-depressive patients may be supersensitive to light. Lancet, i, 383–394.Google Scholar
Lieberman, P. B. E. & Strauss, J. S. (1984) The recurrence of mania: environmental factors and medical treatment. American Journal of Psychiatry, 141, 77–80.Google Scholar
Lingjaerde, O., Bratlid, T., Hansen, T., et al (1986) Seasonal affective disorder and incidental insomnia in the far north. Clinical Neuropharmacology, 9 (suppl. 4), 187–189.Google Scholar
Lowe, M. R. & Batchelor, D. H. (1986) In Depot Antipsychotics in Practice (ed. Silverstone, T.). International Clinical Psychopharmacology, 1, (suppl. 1): 53–62.Google Scholar
Luce, G. G. (1973) Body Time-The Natural Rhythms of the Body. St Albans: Palladin.Google Scholar
Lundquist, G. (1945) Prognosis and course in manic-depressive psychoses: a follow-up study of 319 first admissions. Acta Psychiatrica Scandinavica, (suppl. 35): 1 96.Google Scholar
Lusznat, R. M., Murphy, D. P. & Nunn, C. M. H. (1987) Carbamazepine in the prophylaxis of bipolar affective disorder. International Clinical Psychopharmacology, 2 (suppl. 1): 37–42.Google Scholar
McReadie, R. G., McCormick, M. & Morrison, D. P. (1985) The impact of lithium in south-west Scotland III. The discontinuation of lithium. British Journal of Psychiatry, 146, 77–80.Google Scholar
McReadie, R. G. & Morrison, D. P. (1985) The impact of lithium in south-west Scotland: demographic and clinical findings. British Journal of Psychiatry, 146, 70–74.CrossRefGoogle Scholar
Maj, M., del Vecchio, M., Starace, F., et al (1984) Prediction of affective psychoses response to lithium prophylaxis. Acta Psychiatrica Scandinavica, 69, 37–44.Google Scholar
Mander, A. J., (1986) Is lithium justified after one manic episode? Acta Psychiatrica Scandinavica, 73, 60–67.Google Scholar
Marsden, C. D. (1982) Basal ganglia disease. Lancet, ii, 1141–1146.Google Scholar
Mason, R. (1989) The effect of light on CNS noradrenaline and serotonin receptor function. In Seasonal Affective Disorders (eds Thompson, C. & Silverstone, T.). London: CNS Publications (in press).Google Scholar
Mawson, D. & Smith, A. (1981) Relative humidity and manic admission in the London area. British Journal of Psychiatry, 138, 134–138.Google Scholar
Milkowitz, D. J., Goldstein, M. J., Neuchterlin, K. H., et al (1988) Family factors and the course of bipolar disorder. Archives of General Psychiatry, 45, 225–231.Google Scholar
Milstein, V., Small, J. G., Shelbourne, D., et al (1976) Manic-depressive illness: onset, diurnal temperature and season of birth. Diseases of the Nervous System, 37, 373–375.Google Scholar
Mirin, S. M., Schatzberg, A. F. & Creasey, D. E. (1981) Hypomania and mania after withdrawal of tricyclic antidepressants. American Journal of Psychiatry, 138, 87–89.Google ScholarPubMed
Misra, P. C. & Burns, B. H. (1977) Lithium non-responders in a lithium clinic. Acta Psychiatrica Scandinavica, 55, 32–40.Google Scholar
Morrison, D. P. & McReadie, R. G. (1985) The impact of lithium in south-west Scotland II. A longitudinal study. British Journal of Psychiatry, 146, 74–77.Google Scholar
Morrison, J., Hudgens, R. W. & Barcha, R. (1968). Life events and psychiatric illness. British Journal of Psychiatry, 114, 423–432.Google Scholar
Murphy, D. L. (1972) l-dopa behavioural activation and psychopathology. Research Publications of the Association for Research into Nervous and Mental Diseases, 50, 472–493.Google Scholar
Myers, D. H. & Davies, P. (1978) The seasonal incidence of mania and its relation to climatic variables. Psychological Medicine, 8, 433–440.Google Scholar
Naylor, G. & Scott, C. (1980) Depot injections for affective disorders. British Journal of Psychiatry, 136, 105.Google Scholar
NIMH/NIH Consensus Conference Statement (1985) Mood disorders: pharmacological prevention of recurrences. American Journal of Psychiatry, 142, 469–476.Google Scholar
Nolen, W. A. (1983) Carbamazepine, a possible adjunct or alternative to lithium in bipolar disorders. Acta Psychiatrica Scandinavica, 67, 218–225.Google Scholar
Nurnberger, J. I., Roose, S. P., Dunner, D. L., et al (1979) Unipolar mania: a distinct clinical entity. American Journal of Psychiatry, 136, 1420–1423.Google Scholar
Nurnberger, J. I. & Gershon, E. S. (1984) Genetics of mood disorders. In Neurobiology of Mood Disorders (eds Post, R. M. & Ballenger, J. C.), pp. 76–101. Baltimore: Williams & Wilkins.Google Scholar
O'Connell, R. A., Mayo, J. A., Eng, L. K., et al (1985) Social support and long-term lithium outcome. British Journal of Psychiatry, 147, 272–275.Google Scholar
Okuma, T., Inanga, K. & Itsuki, S. (1981) A preliminary double-blind study of carbamazepine in prophylaxis of manic-depressive illness. Psychopharmacology, 73, 95–96.Google Scholar
O'Rourke, D., Wurtman, J., Brezinski, A., et al (1987) Treatment of seasonal affective disorder with d-fenfluramine. Annals New York Academy of Sciences, 499, 329–330.Google Scholar
O'Shanick, G. J. & Ellinwood, E. E. (1982) Persistent elevation of thyroid stimulating hormone in women with bipolar affective disorder. American Journal of Psychiatry, 139, 513–514.Google Scholar
Parker, G. & Walter, S. (1982) Seasonal variation in depressive disorders and suicidal death in New South Wales. British Journal of Psychiatry, 140, 626–632.Google Scholar
Perris, C. (1966) Study of bipolar (manic-depressive) and unipolar recurrent depressive psychoses. Acta Psychiatrica Scandinavica, 42 (suppl. 194).Google Scholar
Pfohl, B., Vasquez, N. & Nasrallah, H. (1982) Unipolar versus bipolar mania: a review of 247 patients. British Journal of Psychiatry, 141, 453–458.Google Scholar
Pickar, D., Cowdry, R. W., Athanasios, P., et al (1984) Mania and hypomania during antidepressant pharmaco-therapy: clinical and research implications. In Neurobiology of Mood Disorders (eds Post, R. M. & Ballenger, J. C.), pp. 836–845. Baltimore: Williams & Wilkins.Google Scholar
Placidi, G. F., Lenzi, A., Lazzerini, F., et al (1986) The comparative efficacy and safety of carbamazepine versus lithium: a randomised double-blind three year trial in 83 patients. Journal of Clinical Psychiatry, 47, 490–494.Google Scholar
Pollack, H. (1931) Recurrence of attacks of manic-depressive psychosis. American Journal of Psychiatry, 11, 567–574.Google Scholar
Post, R. M., Jimerson, D. C., Bunney, W. E., et al (1980) Dopamine and mania: behavioural and biochemical effects of the dopamine receptor blocker pimozide. Psychopharmacology, 67, 297–305.Google Scholar
Post, R. M., Rubinow, D. R. & Ballenger, J. C. (1984) Conditioning, sensitization and kindling: implications for the course of affective illness. In Neurobiology of Mood Disorders, pp. 432–466. Baltimore: Williams & Wilkins.Google Scholar
Post, R. M., Kramlinger, K. G. & Uhde, T. W. (1987) Carbamazepine-lithium combination: clinical efficacy and side-effects. Drug and Therapeutics Newsletter, 22, 5–8.Google Scholar
Potkin, S. G., Zetin, M., Stamenkovic, V., et al (1986) Seasonal affective disorder, prevalence varies with latitude and climate. Clinical Neuropharmacology, (suppl. 4), 181 183.Google Scholar
Price, L. H., Charney, D. S. & Heninoer, G. R. (1984) Three cases of manic symptoms following yohimbine administration. American Journal of Psychiatry, 141, 1267–1268.Google Scholar
Prien, R. F., Klett, C. J. & Caffey, E. M. (1973) Lithium carbonate and imipramine in prevention of affective episodes. Archives of General Psychiatry, 29, 420–425.Google Scholar
Prien, R. F., Kupfer, D. L., Mansky, P. A., et al (1984) Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders. Archives of General Psychiatry, 41, 1096–1104.Google Scholar
Quitkin, F. M., Kane, J., Rifkin, A., et al (1981) Prophylactic lithium carbonate with and without imipramine for bipolar 1 patients. Archives of General Psychiatry, 38, 902–907.Google Scholar
Reich, T. & Winokur, G. (1970) Post-partum psychoses in patients with manic depressive disease. Journal of Nervous and Mental Disorders, 151, 60–68.Google Scholar
Rennie, T. A. C. (1942) Prognosis in manic-depressive psychoses. American Journal of Psychiatry, 90, 801–814.Google Scholar
Rickaby, G. A. (1977) Four cases of mania associated with bereavement. Journal of Neurological and Mental Disorders, 165, 255–262.Google Scholar
Rihmer, Z. (1980) Season of birth and season of hospital admission in bipolar depressed female patients. Psychiatry Research, 3, 247–251.Google Scholar
Robertson, M. (1987) Molecular genetics of the mind. Nature, 325, 755.CrossRefGoogle ScholarPubMed
Rosenman, S. J. & Taylor, H. (1986) Mania following bereavement, a case report. British Journal of Psychiatry, 148, 468–470.Google Scholar
Rosenthal, N. E., Lewy, A. J., Wehr, T. A., et al (1983) Seasonal cycling in a bipolar patient. Psychiatry Research, 8, 25–31.Google Scholar
Rosenthal, N. E., Sack, D. A., Gillin, J. C., et al (1984) Seasonal affective disorder. Archives of General Psychiatry, 4, 72–80.Google Scholar
Rosenthal, N. E., Sack, D. A., Carpenter, C. J., et al (1985) Antidepressant effects of light in seasonal affective disorder. American Journal of Psychiatry, 142, 163–170.Google Scholar
Rosenthal, N. E., Sack, D. A., Jacobsen, F., et al (1986) Seasonal affective disorder and light: past, present, and future. Clinical Neuropharmacology, 9 (suppl. 4): 193–195.Google Scholar
Roy, A. (1980) Parental loss in childhood and onset of manic-depressive illness. British Journal of Psychiatry, 136, 86–88.Google Scholar
Roy-Byrne, P., Post, R. M., Uhde, T. W., et al (1985) The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH. Acta Psychiatrica Scandinavica (suppl. 317), 1 34.Google Scholar
Schildkraut, J. J. (1965) The catecholamine hypothesis of affective disorders: a review of supporting evidence. American Journal of Psychiatry, 122, 509–512.Google Scholar
Shobe, F. & Brion, P. (1971) Long-term prognosis in manic-depressive illness. Archives of General Psychiatry, 24, 334–337.Google Scholar
Shopsin, B., Gershon, S., Thompson, H., et al (1975) Psychoactive drugs in mania. Archives of General Psychiatry, 32, 34–42.Google Scholar
Silverstone, T. (1984) Response to bromocriptine distinguishes bipolar from unipolar depression. Lancet, i, 903–904.Google Scholar
Silverstone, T. (1985) Dopamine in manic-depressive illness – a pharmacological synthesis. Journal of Affective Disorders, 8, 225–231.Google Scholar
Slater, E. (1938) Zur Periodick des manisch-depressiven irreseins. Zeitschrift Gestalt Neurologie und Psychiatrie, 162, 794–801.Google Scholar
Smals, A. G. H., Ross, H. A. & Kloppenborg, P. W. (1977) Seasonal variation in serum T3 and T4 levels in men. Journal of Clinical Endocrinology and Metabolism, 44, 998–1001.Google Scholar
Spitzer, R., Endicott, J. & Robins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry, 35, 773–782.Google Scholar
Stenstedt, A. (1952) A study of manic-depressive psychosis: clinical, social, and genetic investigations. Acta Psychiatrica Scandinavica, (suppl. 79), 1 111.Google Scholar
Swade, C. & Coppen, A. (1980) Seasonal variations in biochemical factors related to depressive illness. Journal of Affective Disorders, 2, 249–250.Google Scholar
Symonds, R. L. & Williams, P. (1976) Seasonal variations in the incidence of mania. British Journal of Psychiatry, 129, 45–48.Google Scholar
Thompson, C. & Isaacs, G. (1988) Seasonal affective disorder – a British sample: symptomatology in relation to mode of referral and diagnostic sub-type. Journal of Affective Disorders, 14, 1–12.Google Scholar
Transbol, I., Chriastlansen, C. & Baastrup, P. C. (1978) Endocrine effects of lithium I. Hypothyroidism and its prevalence in long-term treated patients. Acta Endocrinologica, 87, 759–767.Google Scholar
Tsuang, M. T. & Woolson, R. F. (1977) Mortality in patients with schizophrenia, mania, depression and surgical conditions. British Journal of Psychiatry, 130, 162–166.Google Scholar
Tyrer, S. P. (1987) Maintenance lithium. Lancet, i, 866.Google Scholar
Van Putten, T. (1975) Why do patients stop lithium? Comprehensive Psychiatry, 16, 179–183.Google Scholar
Vestergaard, P., Amdisen, A. & Schou, M. (1980) Clinically significant side-effects of lithium treatment: a survey of 237 patients on long-term medication. Acta Psychiatrica Scandinavica, 62, 193–200.Google Scholar
Walter, S. D. (1977) Seasonality of mania: a reappraisal. British Journal of Psychiatry, 131, 345–350.Google Scholar
Waters, B., Lapiere, Y., Gagnon, A., et al (1982) Determination of the optimal concentration of lithium. Biological Psychiatry, 17, 1323–1329.Google Scholar
Watkins, S., Callender, K., Thomas, D. R., et al (1987) The effect of carbamezepine and lithium on remission from affective illness. British Journal of Psychiatry, 150, 180–182.Google Scholar
Weeke, A., Juel, K. & Vaeth, M. (1987) Cardiovascular death and manic depressive psychosis. Journal of Affective Disorders, 13, 287–292.Google Scholar
Wehr, T. A. (1984) Biological rhythms and manic-depressive illness. In Neurology of Mood Disorders (eds Post, R. M. & Ballenger, J. C.), pp. 190–206. Baltimore: Williams & Wilkins.Google Scholar
Wehr, T. A. & Goodwin, F. K. (1979) Rapid cycling in manic-depressives induced by tricyclic antidepressants. Archives of General Psychiatry, 36, 555–559.Google Scholar
Wehr, T. A., Wirz-Justice, A., & Goodwin, F. K. (1982) 48-hour sleep/wake cycles in manic-depressive illness: naturalistic observations and sleep deprivation experiments. Archives of General Psychiatry, 39, 559–565.Google Scholar
Wehr, T. A., & Goodwin, F. K. (1987) Can antidepressants cause mania and worsen the course of affective illness? American Journal of Psychiatry, 144, 1403–1411.Google Scholar
Wehr, T. A., Sack, D. A. & Rosenthal, N. E. (1987) Sleep reduction as a final common pathway in the genesis of mania. American Journal of Psychiatry, 144, 201–204.Google Scholar
Winokur, G. (1975) The Iowa 500 heterogeneity and course in manic-depressive illness (bipolar). Comprehensive Psychiatry, 16, 125–131.Google Scholar
Winokur, G., Clayton, P. J. & Reich, T. (1969) Manic Depressive Illness. St Louis: C. V. Mosby.Google Scholar
Wirz-Justice, A. & Richter, R. (1979) Seasonality in biochemical determinations: a source of variance and a clue to the temporal incidence of affective illness. Psychiatry Research, 1, 53–60.Google Scholar
Wirz-Justice, A., Bucheli, C. & Graw, P. (1986) Light treatment of seasonal affective disorder in Switzerland. Acta Psychiatrica Scandinavica, 74, 193–204.Google Scholar
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases. (ICD-9). Geneva: WHO.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.