The Scope of Bipolar Disorders

Recent advances in the epidemiology, psychopathology and pharmacotherapy of bipolar disorders have led to a greater recognition of this illness in all of its varieties (Akiskal et al., 2000). The lifetime risk for bipolar conditions is about 1 % for the core (bipolar I) phenotype, making it at least equal in prevalence to schizophrenia. A higher percentage of acute psychiatric hospital admissions is now being assigned to the category of mania, and the recognition of clinically attenuated outpatient forms of the illness (soft bipolar spectrum) is increasing. The latter (bipolar II and beyond) is now estimated to be at least 4–5 times more prevalent than bipolar I (Angst et al., 2003; Hirschfeld et al., 2003; Judd and Akiskal, 2003). Reasons for the current focus on the entire diagnosable range of bipolar conditions are several. Predominant among these is the tendency of diagnostic practice to follow the availability of effective treatment modalities (Lehmann, 1969). After the discovery of chlorpromazine, North American psychiatrists were tacitly encouraged to elicit subtle degrees of formal thought disorder from their patients so as to bring them the benefits of this new class of drugs. By the early 1970s