[The nosological evolution of bipolar affective disorder]. / A bipoláris affektív zavar nozológiai fejlodése.

The nosological improvement of the bipolar disorder (manic-depression) follow the written history of psychiatry. The symptoms of manic and depressive episodes and mixed states were described in the ancient times. In my summary I accompany the taxonomic improvement, the changing of diagnostic categories and the work of the most important researchers from the beginning to these days.

The description of the litigious querulant: Heinrich von Kleist's Novella Michael Kohlhaas.

OBJECTIVE: To illustrate the use of fiction in understanding psychiatric disorders and refocus attention towards fiction as a valuable source of psychopathology, thereby contributing to the restoration of the narrative in psychiatry. METHOD: A psychopathological analysis of the novella Michael Kohlhaas written by Heinrich von Kleist, one of the outstanding literary figures of the German romantic movement of the early 19th century. RESULTS: The protagonist of Kleist's novella, Michael Kohlhaas, a querulant horse trader, carries out an armed uprising disproportionate to the minor injustice of the unlawful seizure of his horses. Following unsuccessful attempts at legal recourse, Kohlhaas takes up arms against the authorities, and in the course of his uncompromising pursuit of justice eventually sacrifices his own and his family's lives. Kleist accurately portrays Kohlhaas' psychopathological development from a psychologically balanced, emotionally warm family man to one who causes utter destruction, mayhem and the loss of innocent lives. This literary work is a remarkably authentic, insightful and rich representation of litigious/querulant behaviour, described by classical authors as litigious paranoia, a diagnostic category currently subsumed under 'delusional disorder, persecutory type', in DSM-5 and 'persistent delusional disorder' in ICD-10. CONCLUSIONS: Kleist's novella offers important clues to better understand the development of litigious-querulant behaviour and the inner world of its sufferers. An analysis of the novella also illustrates the contribution that fiction could make to resuscitate the narrative as a complement to criterion-based diagnostic practice prevailing in contemporary psychiatry. © 2014 S. Karger AG, Basel.

[Artistic creativity and bipolar mood disorder]. / Muvészi kreativitás es bipoláris kedélyzavar.

BACKGROUND: Several studies and theories propose a connection between psychopathology and artistic creativity i.e. madness and genius characters share common roots. OBJECTIVE: Employing scientific research data, the objective of this review is to elucidate the frequency of psychopathological alterations among writers and artists and to analyse the possible influence of bipolar mood disorder spectrum on the artistic creativity. METHOD: Reviewing studies a) on retrospective investigations, based on biographies of famous persons with high creative achievements, b) on psychiatric examinations of living writers and artists, c) on individual examples of geniuses in the light of their mental status and work output correlations, and d) on creative traits and skills of diagnosed psychiatric patient populations. RESULTS: Beyond the practical experiences and impressions being held for ages from ancient times, the scientific observations and surveys indicate that psychopathological symptoms, especially those belonging to the bipolar mood disorder (bipolar I and II), major depression and cyclothymia categories occur more frequently among writers, poets, visual artists and composers, compared to the rates in the general population. Self-reports of writers and artists describe symptoms in their intensively creative periods which are reminiscent and characteristic of hypomanic states. Further, cognitive styles of hypomania (e.g. overinclusive thinking, richness of associations) and originality-prone creativity share many common as indicated by several authors. Among the eminent artists showing most probably manic-depressive or cyclothymic symptoms were: E. Dickinson, E. Hemingway, N. Gogol, A. Strindberg, V. Woolf, Lord Byron (G. Gordon), J. W. Goethe, V. van Gogh, F. Goya, G. Donizetti, G. F. Händel, O. Klemperer, G. Mahler, R. Schumann, and H. Wolf. Based on biographies and other studies, brief descriptions are given in the present article on the personality character of Gogol; Strindberg, Van Gogh, Händel, Klemperer, Mahler, and Schumann. Further example is the enigmatic silence and withdrawal from opera composing of Gioacchino Rossini (1792-1868), which is still a matter of various theories and explanations. Until his life of 37 years he composed 39 operas and lived almost another 40 years without composing any new one. Biographies show that severe depressive sufferings played a role in that withdrawal and silence, while in his juvenile years most probably hypomanic personality traits contributed to the extreme achievements and very fast composing techniques. Analysing the available biographies of Rossini and the character of music he composed (e.g. opera buffa, Rossini crescendo) strongly suggests the medical diagnosis of a bipolar affective illness. CONCLUSION: Comparing to the general population, bipolar mood disorder is highly overrepresented among writers and artists. The cognitive and other psychological features of artistic creativity resemble many aspects of the hypomanic symptomatology. It may be concluded that bipolar mood traits might contribute to highly creative achievements in the field of art. At the same time, considering the risks, the need of an increased medical care is required.

Cyclothymia, a circular mood disorder.

Ewald Hecker (1843-1909) was a collaborator of Karl Ludwig Kahlbaum (1828-1899). Both worked outside the university and public mental institutions of Germany. By meticulously observing clinical signs and illness-course, they laid the groundwork for modern descriptive psychiatry. Their clinical approach influenced Kraepelin and continues to dominate psychiatric classification. Hecker popularized several of Kahlbaum's syndromal concepts, including hebephrenia. Another was cyclothymia, a relatively benigh form of manic-depressive illness, introduced by Kahlbaum, in 1882. It included depressive (dysthymia), hypomanic (hyperthymia), and mixed hypomanic-depressive phases. The Kahlbaum-Hecker syndrome of cyclothymia survives in DSM-IV bipolar II disorder and cyclothymia. An annotated English translation of Hecker's 1898 paper is provided, with historical notes on Hecker and the significance of his work.

Dysthymia and cyclothymia: historical origins and contemporary development.

The aim of this article is to review and put in their historical context today's data, methodologies and concepts concerning subaffective disorders. The historic roots of dysthymic and cyclothymic disorders--part of the subaffective spectrum--are essentially Greek, but the first use of the word 'dysthymia' in psychiatry was by C.F. Flemming in 1844. E. Hecker introduced the term 'cyclothymia' in 1877. K.L. Kahlbaum (1882) further developed the concepts of hyperthymia, cyclothymia and dysthymia--with possible subthreshold symptomatology--in 1882. After Kraepelin's rubric of 'manic-depressive insanity', the term 'dysthymia' was widely forgotten, and 'cyclothymia' became ill defined. Nowadays the latter term is used in three, partially contradictory, senses: (1) a synonym for bipolar disorder (K. Schneider), (2) a temperament (E. Kretschmer) and (3) a subaffective disorder (DSM-IV, ICD-10). A renaissance of subaffective disorders began with the development of DSM-III. Therapeutically important research has focused on dysthymic disorder and its relationship to major depressive disorder, while cyclothymic disorder is relatively neglected; nonetheless, operationalized as a subaffective dimension or temperament, cyclothymia appears to be a likely precursor or ingredient of the construct of bipolar II disorder.

[Historical aspects of bipolar disorders in French psychiatry]. / Aspects historiques des troubles bipolaires dans la psychiatrie française.

The author presents a digest of the main French reference works on bipolar mood disorders from the outset of the 19th century to 1914. Contributions come essentially from the Paris psychiatric schools of Charenton (Esquirol, Ritti, Antheaume), Salpêtrière (Baillarger, Jean-Pierre and Jules Falret, Deny) and Sainte-Anne (Magnan, Gilbert Ballet). Publications by these authors prepared the ground for Kraepelin's manic-depressive madness (1899). Many clinical pictures recently updated in American psychiatry were described long ago by French authors: hypomania, cyclothymia, mixed bipolar disorders, type II disorders, rapid-cycling forms and seasonal forms. Two intellectual trends were simultaneously active during this period: the first was analytical, syndrome-based and empirical, and maintained that bipolar pathological features were a "disorder" distinct from unipolar depression, much like the American DSM IV; the other synthetic, stage-oriented and more theoretical tradition viewed it as an "illness", a very broad nosological group encompassing most mood disorders.

Anna O. had a severe depressive illness.

The information available on the illness of Anna O. is reviewed together with follow-up data from the literature. It is concluded that the diagnosis of a severe depressive illness with depressive delusions is well justified. Hysterical symptoms which appeared can be understood as part of the depressive state modified by the expectations of the period and by the intervention of physicians. The illness was a very protracted one, with fluctuations or exacerbations lasting from 1880 to 1887, and was complicated by dependence upon morphine and chloral hydrate. However, by 1888, the patient appears to have made a considerable recovery, and she went on to lead an effective and fruitful life, demonstrating high intelligence and the resilience of the cyclothymic temperament.