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The British Journal of Psychiatry 173: 514-518 (1998)
© 1998 The Royal College of Psychiatrists

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

G Perugi, HS Akiskal, L Rossi, A Paiano, C Quilici, D Madaro, L Musetti and GB Cassano
Institute of Psychiatry, University of Pisa, Italy.

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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