OBJECTIVES: The question whether bipolar I disorder should be subdivided into a preponderantly manic group (M) with no depression or only mild depression (Md) and a nuclear manic-depressive group (MD) has been rarely studied although the problem was raised more than 50 years ago. This paper seeks to elucidate this question by contributing further data. METHODS: 406 patients with mood disorders hospitalised at some time during the period 1959-1963 were followed-up every five years until 1985; mortality data were collected up to 1997. Data on episodes, outcome, suicides and attempted suicides, alcohol and substance abuse/dependence and long-term medication, as well as on personality (melancholic and manic type) were collected. Major mood disorders were subclassified according to their hospitalisation for depression (D) and/or mania (M). RESULTS: 30 manic patients (M/Md), 130 bipolar I (MD), 60 bipolar II patients (Dm) and 186 major depressive patients (D) were compared. The manic group differed from the bipolar I group in several variables: better school achievement, milder course of the illness (fewer recurrences), significantly less suicidality and a trend to less chronicity and more recovery. Manic patients required less long-term medication than bipolars and they differed in personality types from bipolars, the personality of manic patients being more often of the manic rather than the melancholic type, they were also more aggressive than bipolars. The family history data showed that the overall morbidity risk of first degree relatives of manic patients was significantly lower than that of bipolar patients. CONCLUSIONS: In accord with several other studies our data point to the existence of a more manic (M/Md) group of bipolar subjects. The diagnosis predicts a better course, lower suicidality and fewer and different treatment needs than does nuclear bipolar I (MD) disorder. The M/Md groups, as clinically interesting subgroups of the mood spectrum, should become a target of further research.
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机译：目的： 尽管这个问题在 50 多年前就已经提出，但很少有人研究双相 I 型障碍是否应该细分为无抑郁症或只有轻度抑郁症 （Md） 和核性躁狂抑郁组 （MD） 的问题。本文试图通过提供进一步的数据来阐明这个问题。方法： 406 例在 1959-1963 年期间住院的情绪障碍患者每五年随访一次，直到 1985 年;收集到1997年的死亡率数据。收集了有关发作、结局、自杀和自杀未遂、酒精和药物滥用/依赖、长期药物以及性格（忧郁型和躁狂型）的数据。主要心境障碍根据其因抑郁症 （D） 和/或躁狂症 （M） 住院的情况进行细分。结果：比较了30例躁狂患者（M/Md）、130例双相I型（MD）、60例双相II型患者（Dm）和186例重度抑郁患者（D）。躁狂组与双相 I 组在几个变量上有所不同：学业成绩更好，病程较轻（复发较少），自杀倾向显着降低，慢性病减少和康复趋势较多。躁狂患者比双相情感障碍患者需要更少的长期药物治疗，他们的性格类型与双相情感障碍不同，躁狂患者的性格通常属于躁狂型而不是忧郁型，他们也比双相情感障碍更具攻击性。家族史数据显示，躁狂患者一级亲属的总体发病风险显著低于双相情感障碍患者。结论：与其他几项研究一致，我们的数据指出存在更躁狂 （M/Md） 的双相情感障碍受试者群体。诊断预测，与核性双相情感障碍 I （MD） 相比，病程更好，自杀率更低，治疗需求更少且不同。M/Md 组作为情绪谱系中临床上有趣的亚组，应成为进一步研究的目标。
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