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Chronic mania

Family history, prior course, clinical picture and social consequences

Published online by Cambridge University Press:  03 January 2018

Giulio Perugi*
Institute of Psychiatry, University of Pisa, Italy
Hagop S. Akiskal
Department of Psychiatry, University of California, San Diego, USA
Luciano Rossi
Institute of Psychiatry, University of Pisa, Italy
Antonic Paiano
Institute of Psychiatry, University of Pisa, Italy
Cinzia Quilici
Institute of Psychiatry, University of Pisa, Italy
Donato Madaro
Institute of Psychiatry, University of Pisa, Italy
Laura Musetti
Institute of Psychiatry, University of Pisa, Italy
Giovanni B. Cassano
Institute of Psychiatry, University of Pisa, Italy
Dr G. Perugi, Institute of Psychiatry, Via Roma 67, 56100, Pisa. Italy. Tel. 39-50-835414; Fax. 39-50-21581



Mania with chronic course has been overlooked in the recent literature. Our aim was clinically to characterise and validate this form of mania.


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.


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.


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 mregalomanic delusions, alienation from loved ones and decreased likelihood of medical and psychiatric care.

Copyright © 1998 The Royal College of Psychiatrists 

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