Skip to main content Accessibility help
×
Home

Bipolar Affective Disorder: Causes and Prevention of Relapse

  • Trevor Silverstone (a1) and Sarah Romans-Clarkson (a2)

Abstract

The majority of patients with bipolar affective disorder relapse at least once during their lifetime, most several times, often with disastrous consequences. In this review we examine those factors which appear to play a facilitatory and in some cases, a causal role in determining whether a relapse will occur and, if so, when. Such factors include: the season of the year, with most admissions for mania in the British Isles occurring in the summer months; change in endocrine status, as after childbirth or when there is impaired thyroid function; treatment with drugs affecting central monoamine, particularly dopamine, neurotransmission; untoward life events. We evaluate the relative efficacy of treatments for the prevention of relapse, such as lithium, carbamazepine and antipsychotics, in the context of social and psychological support systems.

Copyright

Corresponding author

Correspondence

References

Hide All
Abou-Saleh, M. T. (1982) Mania associated with weaning: a hypothesis. British Journal of Psychiatry, 140, 547548.
Abou-Saleh, M. T. & Coppen, A. (1986) Who responds to prophylactic lithium? Journal of Affective Disorders, 10, 115125.
Abrams, R. & Taylor, M. A. (1974) Unipolar mania. Archives of General Psychiatry, 30, 441443.
Abrams, R., Taylor, M. A., Hayman, M. A., et al (1979) Unipolar mania revisited. Journal of Affective Disorders, 1, 5968.
Ahlfors, U. G., Basstrup, P. C., Dencker, S. J., et al (1981) Flupenthixol decoanate in recurrent manic depressive illness. Acta Psychiatrica Scandinavica, 64, 226237.
Ambelas, A. (1979) Psychological stressful events in the precipitation of manic episodes. British Journal of Psychiatry, 135, 1521.
Ambelas, A. (1987) Life events and mania: a special relationship? British Journal of Psychiatry, 150, 235240.
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington, DC: APA.
Angst, J. (1981) Course of affective disorders. In Handbook of Biological Psychiatry (ed. Van Praag, H.), pp. 225242. New York: Marceli Dekker.
Angst, J. (1985) Switch from depression to mania – a recorded study over decades between 1920 and 1982. Pyschopathology, 18, 140154.
Angst, J., Grof, P., Hippius, H. et al (1968) La psychose maniaco-depressive est-elle periodique ou intermittente? In Cycles Biologiques et Psychiatrie (ed. de Ajuriaguerra, H.), pp. 339351. Geneva; Georg et cie.
Angst, J. & Clayton, P. (1986) Premorbid personality of depressive, bipolar and schizophrenic patients with special reference to suicidal issues. Comprehensive Psychiatry, 27, 511532.
Aronson, T. A. & Shukla, S. (1987) Life events and relapse in bipolar disorder: the impact of a catastrophic event. Acta Psychiatrica Scandinavica, 75, 571576.
Astrup, C., Fossum, A. & Holmboe, R. (1959) A follow-up study of 270 patients with acute affective psychoses. Acta Psychiatrica Scandinavica, 34 (suppl. 135), 165.
Baastrup, P. C., Poulsen, J. C., Schou, M., et al (1970) Prophylactic lithium: double-blind discontinuation in manic-depressive disorders. Lancet, ii, 326330.
Ballenger, J. C., & Post, R. M. (1980) Carbamazepine in manic-depressive illness: a new treatment. American Journal of Psychiatry, 137, 782790.
Bech, P., Vendsborg, P. B., & Rafaelson, O. J. (1976) Lithium maintenace treatment of manic melancholic patients: its role in the daily routine. Acta Psychiatrica Scandinavica, 53, 7081.
Benson, R. (1976) Psychological stress as a cause of lithium prophylaxis failure: a report of three cases. Diseases of the Nervous System, 37, 699700.
Bidzinksa, E. J. (1984) Stress factors in affective diseases. British Journal of Psychiatry, 144, 161166.
Black, D. W., Winokur, G. & Nasrallah, A. (1987) Suicide in subtypes of major affective disorder. Archives of General Psychiatry, 44, 878880.
Bland, R. C. & Orn, H. (1982) Course and outcome in affective disorders. Canadian Journal of Psychiatry, 27, 573578.
Boyd, J. H. & Weissman, M. M. (1982) Epidemiology. In Handbook of Affective Disorders (ed. Paykel, E. S.), pp. 109125. Edinburgh: Churchill Livingstone.
Bratfos, D. & Haug, J. D. (1968) The course of manic-depressive psychosis. Acta Psychiatrica Scandinavica, 44, 89112.
Brown, G. W., & Harris, T. (1978) Social Origins of Depression. London: Tavistock Publications.
Bunney, W. E. (1978) Psychopharmacology of the switch process in affective disorders. In Psychopharmacology: A Generation of Progress (eds Lipton, M. A., Marcio, A. D., Killam, K. F.), pp. 12491259. New York, Raven Press.
Bunney, W. E. & Gurland-Bunney, B. L. (1987) Mechanisms of action of lithium in affective illness. In Psychopharmacology: A Third Generation of Progress (ed. Meltzer, H. Y.), pp. 553565. New York: Raven Press.
Carlson, G. A., Kotin, J., Davenport, Y. B., et al (1974) Follow-up of 53 bipolar manic-depressive patients. British Journal of Psychiatry, 124, 134139.
Carlsson, A., Svennerholm, L., & Winblad, B. (1980) Seasonal and circadian monoamine variations in human brain examined post-mortem. Acta Psychiatrica Scandinavica, 61 (suppl. 280), 7583.
Carney, A. (1989) Influence of climate on the prevalence of mania. In Seasonal Affective Disorders (eds Thompson, C. & Silverstone, T.). London: CNS Publications (in press).
Carrol, B. J. (1979) Prediction of treatment outcome with lithium. Archives of General Psychiatry, 36, 870878.
Checkley, S. A. (1978) Thyrotoxicosis and the course of manic-depressive illness. British Journal of Psychiatry, 133, 219233.
Cho, J. T., Bone, S. & Dunner, D. L. (1979) The effect of lithium treatment on thyroid function in patients with primary affective disorder. American Journal of Psychiatry, 136, 115116.
Chouinard, G., Young, S. N. & Annable, L. (1983) Antimanic effect of clonazepam. Biological Psychiatry, 18, 451466.
Chung, R. K., Langeluddecke, P. & Tennant, C. (1986) Threatening life events in the onset of schizophrenia, schizophreniform psychosis and hypomania. British Journal of Psychiatry, 148, 680685.
Cohen, B. M., Lipinski, J. F. & Altesman, R. I. (1982) Lecithin in the treatment of mania. American Journal of Psychiatry, 139, 11621164.
Cookson, J. C. (1981) Oestrogens, dopamine and mood. British Journal of Psychiatry, 139, 365366.
Cookson, J. C. (1982) Post-partum mania, dopamine and oestrogens. Lancet, ii, 672.
Cookson, J. C. (1985) The neuroendocrinology of mania. Journal of Affective Disorders, 8, 233241.
Cookson, J. C. & Silverstone, T. (1976) 5-hydroxytryptamine and dopamine pathways in mania: a pilot study of fenfluramine and pimozide. British Journal of Clinical Pharmacology, 3, 942943.
Cookson, J. C., Silverstone, T. & Wells, B. (1981) A double-blind comparative clinical trial of pimozide and chlorpromazine in mania – a test of the dopamine hypothesis. Acta Psychiatrica Scandinavica, 64, 381397.
Coppen, A., Noguera, R., Bailey, J., et al (1971) Prophylactic lithium in affective disorders. Lancet, ii, 275279.
Coppen, A., Montgomery, S. A., Gupta, R. K., et al (1976) Decreasing lithium dosage reduces morbidity and side-effects during prophylaxis. Journal of Affective Disorders, 6, 353362.
Corn, T. H. & Checkley, S. A. (1983) A case of recurrent mania with recurrent hyperthyroidism. British Journal of Psychiatry, 143, 7476.
Coryell, W., Andreasen, N., Endicott, J., et al (1987) The significance of past mania or hypomania in the course and outcome of major depression. American Journal of Psychiatry, 144, 309315.
Cowdry, R. W., Wehr, T. A., Zis, A. P., et al (1983) Thyroid abnormalities associated with rapid cycling bipolar illness. Archives of General Psychiatry, 40, 414420.
Cutler, N. R. & Post, R. M. (1982) Life course of illness in untreated manic depressive patients. Comprehensive Psychiatry, 23, 101108.
Davis, K. L., Berger, P. A., Hollister, L. E., et al (1978) Physostigmine in mania. Archives of General Psychiatry, 35, 119122.
Dean, C. & Kendell, R. E. (1981) The symptomatology of puerperal illness. British Journal of Psychiatry, 139, 128133.
Dickson, W. E. & Kendell, R. E. (1986) Does maintenance lithium prevent recurrences of mania under ordinary clinical conditions? Psychological Medicine, 16, 521530.
Dietzel, M., Saletu, B., Lesch, O. M., et al (1986) Light treatment in depressive illness. Polysomnographic, psychometric and neuroendocrine findings. European Neurology, 25 (suppl. 2), 93103.
Dilsaver, S. C., Greden, J. F. & Snider, R. M. (1987) Antidepressant withdrawal syndromes: phenomenology and pathophysiology. International Clinical Psychopharmacology, 2, 119.
Di Paola, T., Poyet, P. & Labrie, F. (1981) Effects of chronic oestradiol and haloperidol treatment on striated dopamine receptors. Journal of Pharmacology, 73, 105106.
Di Paola, T., Fleiss, J. L. & Fieve, R. R. (1976) Lithium carbonate prophylaxis failure. British Journal of Psychiatry, 129, 4044.
Di Paola, T., Fleiss, J. L. & Fieve, R. R. (1977) Rapid cycling manic depressive illness. Comprehensive Psychiatry, 18, 561566.
Di Paola, T., Fleiss, J. L. & Fieve, R. R. (1979) Life events at the onset of bipolar affective illness. American Journal of Psychiatry, 136, 508511.
Durkheim, E. (1897) Le Suicide: étude de sociologie. Paris: Alcan.
Eastwood, M. R. & Stiasny, S. (1978) Psychiatric disorder, hospital admission and season. Archives of General Psychiatry, 35, 769771.
Egeland, J. A., Gerhard, D. S., Pauls, D. L., et al (1987) Bipolar affective disorder linked to DNA markers on chromosome 11. Nature, 325, 783787.
Emrich, H. M., Dose, M. & Von Zerssen, D. (1985) The use of sodium valporate carbamazepine and oxycarbamazepine in patients with affective disorders. Journal of Affective Disorders, 8, 243250.
Esparon, J., Kolloori, J., Naylor, G. J., et al (1986) Comparison of the prophylactic action of flupenthixol with placebo in lithium-treated manic-depressive patients. British Journal of Psychiatry, 148, 723725.
Esquirol, J. E. D. (1845) Des Maladies Mentales (trans. Hunt, E. K.). Philadelphia: Lea and Blanchard.
Extein, I., Pottash, A. L. C. & Gold, M. S. (1982) Does subclinical hypothyroidism predispose to tricyclic-induced rapid mood cycles? Journal of Clinical Psychiatry, 43, 290291.
Fadden, G., Bebbington, P. & Kuipors, L. (1987) Caring and its burdens: a study of spouses of depressed patients. British Journal of Psychiatry, 151, 660667.
Fleiss, J. L., Prien, R., Dunner, D. L., et al (1978) Actuarial studies of the course of manic depressive illness. Comprehensive Psychiatry, 19, 355362.
Folks, D. G., King, D. L. & Dowdy, S. B. (1982) Carbamazepine treatment of selected affectively disordered patients. American Journal of Psychiatry, 139, 115117.
Folstein, M. F., de Paulo, J. R. & Trepp, K. (1982) Unusual mood stability in patients taking lithium. British Journal of Psychiatry, 140, 188191.
Forrest, A. D., Fraser, R. H. & Priest, R. G. (1965) Environmental factors in depressive illness. British Journal of Psychiatry, 111, 243253.
Frangos, A., Athanassenas, G., Tsitourides, S., et al (1980) Seasonality of the episodes of recurrent affective psychoses: possible prophylactic interventions. Journal of Affective Disorders, 2, 239247.
Garattini, S., Menini, T. & Bendotti, C. (1986) Neurochemical mechanism of action of drugs which modify feeding via the serotenergic system. Appetite, 7 (suppl.): 1538.
Gerner, R. H., Post, R. M. & Bunney, W. E. (1976) A dopaminergic mechanism in mania. American Journal of Psychiatry, 133, 11771180.
Glassner, B., Haldipur, C. V. & Dessaversmith, J. J. (1979) Role loss and working-class manic-depression. Journal of Nervous and Mental Diseases, 167, 530541.
Glassner, B. & Haldipur, C. V. (1983) Life events and early and late onset of bipolar disorder. American Journal of Psychiatry, 140, 215217.
Gold, P. W. & Rubinow, D. R. (1987) Neuropeptide function in affective illness. In Psychopharmacology: The Third Generation of Progress (ed. Meltzer, H. T.), pp. 617627. New York: Raven Press.
Goodnick, P. J., Fieve, R. R. & Schlegel, A. (1987) Clinical and chemical effects of lithium discontinuation. American Journal of Psychiatry, 144, 385.
Goodnick, P. J., Fieve, R. R., Schlegel, A., et al (1987) Prediction of interepisode symptoms and relapse in affective disorder patients treated with lithium carbonate. American Journal of Psychiatry, 144, 367369.
Goodwin, F. K. & Jamison, K. R. (1984) The natural course of manic–depressive illness. In Neurobiology of Mood Disorders (eds Post, R. M. & Ballenger, J. C.), pp. 2038. Baltimore: Williams & Wilkins.
Haag, H., Heidorn, A., Greil, W., et al (1986) Sequence of affective polarity and response to stabilising lithium therapy. Comprehensive Psychiatry, 18, 497502.
Hall, K. S. (1984) A prospective study of life events and affective episodes in a population of manic depressive patients. PhD thesis, Columbia University.
Hall, K. S., Dunner, D. L., Zeller, G., et al (1977) Bipolar illness: a prospective study of life events. Comprehensive Psychiatry, 18, 497502.
Hardy, M. C., Lecrubier, Y. & Widlocher, D. (1986) Efficacy of Clonidine in 24 patients with acute mania. American Journal of Psychiatry, 143, 14501453.
Hare, E. & Walter, S. D. (1978) Seasonal variation in admissions of psychiatric patients and its relation to seasonal variation in their birth. Journal of Epidemiology and Community Health, 32, 4752.
Hippocrates (1938) On Airs, Waters and Places. Medical Classics, Vol. 3. Baltimore: Williams & Wilkins.
Hirschfeld, R. M. A., Klerman, G. L., Keller, M. B., et al (1986) Personality of recovered patients with bipolar affective disorder. Journal of Affective Disorders, 11, 8189.
Hodgkinson, S., Sherrington, R., Gurling, H., et al (1987) Molecular genetic evidence for heterogeneity in manic depression. Nature, 325, 805806.
Hollender, M. H. & Goldin, M. L. (1978) Single case study: funeral mania. Journal of Nervous and Mental Disease, 166, 890892.
Horesh, N., Lepkitker, E., Milgram, N., et al (1987) Presented at International Conference on New Directions in Affective Disorders, Jerusalem.
Isaacs, G. & Thompson, C. (1988) Phototherapy and its mechanism of action. Journal of Affective Disorders, 14, 1320.
James, N. & Chapman, C. J. (1975) A genetic study of bipolar affective disorder. British Journal of Psychiatry, 126, 449456.
James, S. P., Wehr, T. A., Sack, D. A., et al (1985) Treatment of seasonal affective disorder with light in the evening. British Journal of Psychiatry, 147, 442448.
Jamison, K. R., Gerner, R. H. & Goodwin, J. K. (1979) Patient and physician attitudes towards lithium: relation to compliance. Archives of General Psychiatry, 36, 866869.
Jamison, K. R. & Akiskal, H. S. (1983) Medication compliance in patients with bipolar disorder. Psychiatric Clinics of North America, 6, 175192.
Janowsky, D. S., El Yousef, M. K. & Davis, J. M. (1973) Parasympathetic suppression of manic symptoms by physostigmine. Archives of General Psychiatry, 28, 542547.
Jauhar, P. & Weller, M. P. I. (1982) Psychiatric morbidity and time zone changes: a studTy of patients from Heathrow Airport. British Journal of Psychiatry, 140, 231235.
Jenner, F. A., Goodwin, J. C., Sheridan, M., et al (1968) The effect of an altered time regime on biological rhythms in a 48 hour periodic psychosis. British Journal of Psychiatry, 114, 215224.
Jimerson, D. C. (1987) Role of dopamine mechanisms in the affective disorders. In Psychopharmacology: The Third Generation of Progress (ed. Meltzer, H. Y.), pp. 505511. New York: Raven Press.
Jones, B. D., Steinberg, S. & Chouinard, G. (1984) Fast-cycling bipolar disorder induced by withdrawal from long-term treatment with a tricyclic antidepressant. American Journal of Psychiatry, 141, 108109.
Josephson, A. M. & Mackenzie, T. B. (1979) Appearance of manic psychosis following rapid normalization of the thyroid status. American Journal of Psychiatry, 136, 846847.
Josephson, A. M. & Mackenzie, T. B. (1980) Thyroid induced mania in hypothyroid patients. British Journal of Psychiatry, 137, 222228.
Joyce, P. R. (1984) Parental bonding in bipolar affective disorder. Journal of Affective Disorders, 7, 319324.
Joyce, P. R. (1985) Illness behaviour and rehospitalisation in bipolar affective disorder. Psychological Medicine, 15, 521525.
Joyce, P. R., Rogers, J. R. M. & Anderson, E. D. (1981) Mania associated with weaning. British Journal of Psychiatry, 139, 355356.
Kadrmas, A., Winokur, G. & Crow, R. (1979) Post-partum mania. British Journal of Psychiatry, 135, 551554.
Katona, C. L. E. (1982) Puerperal mental illness: a comparison with non-puerperal controls. British Journal of Psychiatry, 141, 447452.
Kennedy, S., Thompson, R., Stancer, H. C., et al (1983) Life events precipitating mania. British Journal of Psychiatry, 142, 358403.
Kocsis, J. H. & Stokes, P. E. (1979) Lithium maintenance: factors affecting outcome. American Journal of Psychiatry, 136, 563566.
Kraepelin, E. (1921) Manic-depressive Insanity and Paranoia (trans Barclay, R. M.). Edinburgh: E. & S. Livingstone.
Krauthammer, C., & Klerman, G. (1978) Secondary mania. Manic syndromes associated with antecedent physical illness or drugs. Archives of General Psychiatry, 35, 13331339.
Kukopulos, A. & Reginaldi, D. (1980) Recurrences of manic-depressive episodes during lithium treatment. Handbook of Lithium Therapy (ed. Johnson, F. N.), pp. 109117. Lancaster: MTP.
Kukopulos, A., Reginaldi, D., Laddomada, P., et al (1980) Course of manic-depressive cycle and changes caused by treatments. Pharmakopsychiatry, 13, 156157.
Lazarus, J. H., John, R., Bennie, E. H., et al (1981) Lithium therapy and thyroid function: a long-term study. Psychological Medicine, 11, 8592.
Lazarus, J. H., McGregor, A. M., Ludgate, M., et al (1986) Effect of lithium carbonate therapy on thyroid immune status in manic-depressive patients: a prospective study. Journal of Affective Disorders, 11, 155160.
Leff, J., Fischer, M. & Bertelsen, A. C. (1976) A cross national epidemiological study of mania. British Journal of Psychiatry, 129, 428442.
Leonhard, K. (1959) Aufeiling der Endogenen Psychosen (2nd edn). Berlin.
Lewy, A. J., Wehr, T. A., Goodwin, F. K., et al (1981) Manic-depressive patients may be supersensitive to light. Lancet, i, 383394.
Lieberman, P. B. E. & Strauss, J. S. (1984) The recurrence of mania: environmental factors and medical treatment. American Journal of Psychiatry, 141, 7780.
Lingjaerde, O., Bratlid, T., Hansen, T., et al (1986) Seasonal affective disorder and incidental insomnia in the far north. Clinical Neuropharmacology, 9 (suppl. 4), 187189.
Lowe, M. R. & Batchelor, D. H. (1986) In Depot Antipsychotics in Practice (ed. Silverstone, T.). International Clinical Psychopharmacology, 1, (suppl. 1): 5362.
Luce, G. G. (1973) Body Time-The Natural Rhythms of the Body. St Albans: Palladin.
Lundquist, G. (1945) Prognosis and course in manic-depressive psychoses: a follow-up study of 319 first admissions. Acta Psychiatrica Scandinavica, (suppl. 35): 1 96.
Lusznat, R. M., Murphy, D. P. & Nunn, C. M. H. (1987) Carbamazepine in the prophylaxis of bipolar affective disorder. International Clinical Psychopharmacology, 2 (suppl. 1): 3742.
McReadie, R. G., McCormick, M. & Morrison, D. P. (1985) The impact of lithium in south-west Scotland III. The discontinuation of lithium. British Journal of Psychiatry, 146, 7780.
McReadie, R. G. & Morrison, D. P. (1985) The impact of lithium in south-west Scotland: demographic and clinical findings. British Journal of Psychiatry, 146, 7074.
Maj, M., del Vecchio, M., Starace, F., et al (1984) Prediction of affective psychoses response to lithium prophylaxis. Acta Psychiatrica Scandinavica, 69, 3744.
Mander, A. J., (1986) Is lithium justified after one manic episode? Acta Psychiatrica Scandinavica, 73, 6067.
Marsden, C. D. (1982) Basal ganglia disease. Lancet, ii, 11411146.
Mason, R. (1989) The effect of light on CNS noradrenaline and serotonin receptor function. In Seasonal Affective Disorders (eds Thompson, C. & Silverstone, T.). London: CNS Publications (in press).
Mawson, D. & Smith, A. (1981) Relative humidity and manic admission in the London area. British Journal of Psychiatry, 138, 134138.
Milkowitz, D. J., Goldstein, M. J., Neuchterlin, K. H., et al (1988) Family factors and the course of bipolar disorder. Archives of General Psychiatry, 45, 225231.
Milstein, V., Small, J. G., Shelbourne, D., et al (1976) Manic-depressive illness: onset, diurnal temperature and season of birth. Diseases of the Nervous System, 37, 373375.
Mirin, S. M., Schatzberg, A. F. & Creasey, D. E. (1981) Hypomania and mania after withdrawal of tricyclic antidepressants. American Journal of Psychiatry, 138, 8789.
Misra, P. C. & Burns, B. H. (1977) Lithium non-responders in a lithium clinic. Acta Psychiatrica Scandinavica, 55, 3240.
Morrison, D. P. & McReadie, R. G. (1985) The impact of lithium in south-west Scotland II. A longitudinal study. British Journal of Psychiatry, 146, 7477.
Morrison, J., Hudgens, R. W. & Barcha, R. (1968). Life events and psychiatric illness. British Journal of Psychiatry, 114, 423432.
Murphy, D. L. (1972) l-dopa behavioural activation and psychopathology. Research Publications of the Association for Research into Nervous and Mental Diseases, 50, 472493.
Myers, D. H. & Davies, P. (1978) The seasonal incidence of mania and its relation to climatic variables. Psychological Medicine, 8, 433440.
Naylor, G. & Scott, C. (1980) Depot injections for affective disorders. British Journal of Psychiatry, 136, 105.
NIMH/NIH Consensus Conference Statement (1985) Mood disorders: pharmacological prevention of recurrences. American Journal of Psychiatry, 142, 469476.
Nolen, W. A. (1983) Carbamazepine, a possible adjunct or alternative to lithium in bipolar disorders. Acta Psychiatrica Scandinavica, 67, 218225.
Nurnberger, J. I., Roose, S. P., Dunner, D. L., et al (1979) Unipolar mania: a distinct clinical entity. American Journal of Psychiatry, 136, 14201423.
Nurnberger, J. I. & Gershon, E. S. (1984) Genetics of mood disorders. In Neurobiology of Mood Disorders (eds Post, R. M. & Ballenger, J. C.), pp. 76101. Baltimore: Williams & Wilkins.
O'Connell, R. A., Mayo, J. A., Eng, L. K., et al (1985) Social support and long-term lithium outcome. British Journal of Psychiatry, 147, 272275.
Okuma, T., Inanga, K. & Itsuki, S. (1981) A preliminary double-blind study of carbamazepine in prophylaxis of manic-depressive illness. Psychopharmacology, 73, 9596.
O'Rourke, D., Wurtman, J., Brezinski, A., et al (1987) Treatment of seasonal affective disorder with d-fenfluramine. Annals New York Academy of Sciences, 499, 329330.
O'Shanick, G. J. & Ellinwood, E. E. (1982) Persistent elevation of thyroid stimulating hormone in women with bipolar affective disorder. American Journal of Psychiatry, 139, 513514.
Parker, G. & Walter, S. (1982) Seasonal variation in depressive disorders and suicidal death in New South Wales. British Journal of Psychiatry, 140, 626632.
Perris, C. (1966) Study of bipolar (manic-depressive) and unipolar recurrent depressive psychoses. Acta Psychiatrica Scandinavica, 42 (suppl. 194).
Pfohl, B., Vasquez, N. & Nasrallah, H. (1982) Unipolar versus bipolar mania: a review of 247 patients. British Journal of Psychiatry, 141, 453458.
Pickar, D., Cowdry, R. W., Athanasios, P., et al (1984) Mania and hypomania during antidepressant pharmaco-therapy: clinical and research implications. In Neurobiology of Mood Disorders (eds Post, R. M. & Ballenger, J. C.), pp. 836845. Baltimore: Williams & Wilkins.
Placidi, G. F., Lenzi, A., Lazzerini, F., et al (1986) The comparative efficacy and safety of carbamazepine versus lithium: a randomised double-blind three year trial in 83 patients. Journal of Clinical Psychiatry, 47, 490494.
Pollack, H. (1931) Recurrence of attacks of manic-depressive psychosis. American Journal of Psychiatry, 11, 567574.
Post, R. M., Jimerson, D. C., Bunney, W. E., et al (1980) Dopamine and mania: behavioural and biochemical effects of the dopamine receptor blocker pimozide. Psychopharmacology, 67, 297305.
Post, R. M., Rubinow, D. R. & Ballenger, J. C. (1984) Conditioning, sensitization and kindling: implications for the course of affective illness. In Neurobiology of Mood Disorders, pp. 432466. Baltimore: Williams & Wilkins.
Post, R. M., Kramlinger, K. G. & Uhde, T. W. (1987) Carbamazepine-lithium combination: clinical efficacy and side-effects. Drug and Therapeutics Newsletter, 22, 58.
Potkin, S. G., Zetin, M., Stamenkovic, V., et al (1986) Seasonal affective disorder, prevalence varies with latitude and climate. Clinical Neuropharmacology, (suppl. 4), 181 183.
Price, L. H., Charney, D. S. & Heninoer, G. R. (1984) Three cases of manic symptoms following yohimbine administration. American Journal of Psychiatry, 141, 12671268.
Prien, R. F., Klett, C. J. & Caffey, E. M. (1973) Lithium carbonate and imipramine in prevention of affective episodes. Archives of General Psychiatry, 29, 420425.
Prien, R. F., Kupfer, D. L., Mansky, P. A., et al (1984) Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders. Archives of General Psychiatry, 41, 10961104.
Quitkin, F. M., Kane, J., Rifkin, A., et al (1981) Prophylactic lithium carbonate with and without imipramine for bipolar 1 patients. Archives of General Psychiatry, 38, 902907.
Reich, T. & Winokur, G. (1970) Post-partum psychoses in patients with manic depressive disease. Journal of Nervous and Mental Disorders, 151, 6068.
Rennie, T. A. C. (1942) Prognosis in manic-depressive psychoses. American Journal of Psychiatry, 90, 801814.
Rickaby, G. A. (1977) Four cases of mania associated with bereavement. Journal of Neurological and Mental Disorders, 165, 255262.
Rihmer, Z. (1980) Season of birth and season of hospital admission in bipolar depressed female patients. Psychiatry Research, 3, 247251.
Robertson, M. (1987) Molecular genetics of the mind. Nature, 325, 755.
Rosenman, S. J. & Taylor, H. (1986) Mania following bereavement, a case report. British Journal of Psychiatry, 148, 468470.
Rosenthal, N. E., Lewy, A. J., Wehr, T. A., et al (1983) Seasonal cycling in a bipolar patient. Psychiatry Research, 8, 2531.
Rosenthal, N. E., Sack, D. A., Gillin, J. C., et al (1984) Seasonal affective disorder. Archives of General Psychiatry, 4, 7280.
Rosenthal, N. E., Sack, D. A., Carpenter, C. J., et al (1985) Antidepressant effects of light in seasonal affective disorder. American Journal of Psychiatry, 142, 163170.
Rosenthal, N. E., Sack, D. A., Jacobsen, F., et al (1986) Seasonal affective disorder and light: past, present, and future. Clinical Neuropharmacology, 9 (suppl. 4): 193195.
Roy, A. (1980) Parental loss in childhood and onset of manic-depressive illness. British Journal of Psychiatry, 136, 8688.
Roy-Byrne, P., Post, R. M., Uhde, T. W., et al (1985) The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH. Acta Psychiatrica Scandinavica (suppl. 317), 1 34.
Schildkraut, J. J. (1965) The catecholamine hypothesis of affective disorders: a review of supporting evidence. American Journal of Psychiatry, 122, 509512.
Shobe, F. & Brion, P. (1971) Long-term prognosis in manic-depressive illness. Archives of General Psychiatry, 24, 334337.
Shopsin, B., Gershon, S., Thompson, H., et al (1975) Psychoactive drugs in mania. Archives of General Psychiatry, 32, 3442.
Silverstone, T. (1984) Response to bromocriptine distinguishes bipolar from unipolar depression. Lancet, i, 903904.
Silverstone, T. (1985) Dopamine in manic-depressive illness – a pharmacological synthesis. Journal of Affective Disorders, 8, 225231.
Slater, E. (1938) Zur Periodick des manisch-depressiven irreseins. Zeitschrift Gestalt Neurologie und Psychiatrie, 162, 794801.
Smals, A. G. H., Ross, H. A. & Kloppenborg, P. W. (1977) Seasonal variation in serum T3 and T4 levels in men. Journal of Clinical Endocrinology and Metabolism, 44, 9981001.
Spitzer, R., Endicott, J. & Robins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry, 35, 773782.
Stenstedt, A. (1952) A study of manic-depressive psychosis: clinical, social, and genetic investigations. Acta Psychiatrica Scandinavica, (suppl. 79), 1 111.
Swade, C. & Coppen, A. (1980) Seasonal variations in biochemical factors related to depressive illness. Journal of Affective Disorders, 2, 249250.
Symonds, R. L. & Williams, P. (1976) Seasonal variations in the incidence of mania. British Journal of Psychiatry, 129, 4548.
Thompson, C. & Isaacs, G. (1988) Seasonal affective disorder – a British sample: symptomatology in relation to mode of referral and diagnostic sub-type. Journal of Affective Disorders, 14, 112.
Transbol, I., Chriastlansen, C. & Baastrup, P. C. (1978) Endocrine effects of lithium I. Hypothyroidism and its prevalence in long-term treated patients. Acta Endocrinologica, 87, 759767.
Tsuang, M. T. & Woolson, R. F. (1977) Mortality in patients with schizophrenia, mania, depression and surgical conditions. British Journal of Psychiatry, 130, 162166.
Tyrer, S. P. (1987) Maintenance lithium. Lancet, i, 866.
Van Putten, T. (1975) Why do patients stop lithium? Comprehensive Psychiatry, 16, 179183.
Vestergaard, P., Amdisen, A. & Schou, M. (1980) Clinically significant side-effects of lithium treatment: a survey of 237 patients on long-term medication. Acta Psychiatrica Scandinavica, 62, 193200.
Walter, S. D. (1977) Seasonality of mania: a reappraisal. British Journal of Psychiatry, 131, 345350.
Waters, B., Lapiere, Y., Gagnon, A., et al (1982) Determination of the optimal concentration of lithium. Biological Psychiatry, 17, 13231329.
Watkins, S., Callender, K., Thomas, D. R., et al (1987) The effect of carbamezepine and lithium on remission from affective illness. British Journal of Psychiatry, 150, 180182.
Weeke, A., Juel, K. & Vaeth, M. (1987) Cardiovascular death and manic depressive psychosis. Journal of Affective Disorders, 13, 287292.
Wehr, T. A. (1984) Biological rhythms and manic-depressive illness. In Neurology of Mood Disorders (eds Post, R. M. & Ballenger, J. C.), pp. 190206. Baltimore: Williams & Wilkins.
Wehr, T. A. & Goodwin, F. K. (1979) Rapid cycling in manic-depressives induced by tricyclic antidepressants. Archives of General Psychiatry, 36, 555559.
Wehr, T. A., Wirz-Justice, A., & Goodwin, F. K. (1982) 48-hour sleep/wake cycles in manic-depressive illness: naturalistic observations and sleep deprivation experiments. Archives of General Psychiatry, 39, 559565.
Wehr, T. A., & Goodwin, F. K. (1987) Can antidepressants cause mania and worsen the course of affective illness? American Journal of Psychiatry, 144, 14031411.
Wehr, T. A., Sack, D. A. & Rosenthal, N. E. (1987) Sleep reduction as a final common pathway in the genesis of mania. American Journal of Psychiatry, 144, 201204.
Winokur, G. (1975) The Iowa 500 heterogeneity and course in manic-depressive illness (bipolar). Comprehensive Psychiatry, 16, 125131.
Winokur, G., Clayton, P. J. & Reich, T. (1969) Manic Depressive Illness. St Louis: C. V. Mosby.
Wirz-Justice, A. & Richter, R. (1979) Seasonality in biochemical determinations: a source of variance and a clue to the temporal incidence of affective illness. Psychiatry Research, 1, 5360.
Wirz-Justice, A., Bucheli, C. & Graw, P. (1986) Light treatment of seasonal affective disorder in Switzerland. Acta Psychiatrica Scandinavica, 74, 193204.
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases. (ICD-9). Geneva: WHO.

Bipolar Affective Disorder: Causes and Prevention of Relapse

  • Trevor Silverstone (a1) and Sarah Romans-Clarkson (a2)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Bipolar Affective Disorder: Causes and Prevention of Relapse

  • Trevor Silverstone (a1) and Sarah Romans-Clarkson (a2)
Submit a response

eLetters

We encountered an error trying to retrieve eLetters for this article. Please try again or contact Customer Services

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *