Vol 10, No 2 Dialogues in Clinical Neuroscience - Developments in Bipolar Disorder
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ear Colleagues, The concept of bipolarity is an ancient one, and involves two mood states: a depressive one, with psychomo- tor slowing and a melancholia-like syndrome, and a manic state, with flight of ideas, euphoria, and positive psy- chomotor signs. Together, these two states form one disorder, known as manic-depressive psychosis.This is the most extreme form of bipolar disorder.There are other forms of the disorder which are less extreme, or atypical, giving clinical pic- tures representing a more skewed bipolarity, tending either toward the positive—or manic—pole, or to the nega- tive—or depressive—pole. Subsidiary clinical forms can also be seen, eg, cyclothymias (anxious cyclothymias), forms with a dominant positive pole (states of hypomania or isolated mania), forms with a prevalent depressive component (or with a pos- itive pole that is only hypomanic, with a melancholic depressive state) and atypical forms, such as schizoaffective dis- order, etc. The common denominator of these states is the appearance of positive and negative episodes of varying degrees of intensity, and unpredictable symptom-free periods. The pathology can be described both quantitatively, by analyzing the relative predominance of the positive and negative syndromes, and qualitatively, by looking at which, if any, atypical features accompany the episodes, which psychomotor features are present, and also at the length of the intervals between episodes, and the nature of these intervals (true symptom-free periods, atypical elements). The notion of periodicity and of a symptom-free period are extremely interesting to clinicians today.The clin- ical study of rhythms shows that many central nervous system (CNS) pathologies have bipolar elements, which gives them a particular clinical relevance, and presents particular treatment options.The close ties between CNS patholo- gies and bipolar disorders are logical, given that their internal synchronizers are centrally located. Interest in this approach is made even greater by: - The fact that certain addictive behaviors are added to these clinical pictures - The fact that new treatments for rhythm disorders are now on the market. Bipolar disorders have thus become one of the main current concerns in psychiatry, as much due to the increasing interest in rhythm abnormalities as to the large number of studies that have re-examined the area from a clinical and neurobiological point of view. One should also point out that there are a number of comorbid disorders presenting phase disruptions. We felt it was essential to provide an update of the knowledge in this field, and Prof Barry Lebowitz agreed to coordinate an issue to this end. For this issue of Dialogues in Clinical Neuroscience, he was able to assemble a panel of outstanding authors, who have addressed the most relevant points in this area. We thank them all for their contributions to this extremely interesting issue. Sincerely yours, Jean-Paul Macher, MD E d i t o r i a l D