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The Mystery of Unipolar Mania: How Is It Different from Bipolar Disorder?
Unipolar mania is a specific psychiatric disorder that is similar in form to bipolar disorder, but is characterized by the individual experiencing only manic episodes, without depressive episodes. Symptoms of depression are often accompanied by persistent low mood, loss of energy, and suicidal thoughts. Recent studies have found that manic states are often characterized by racing thoughts, less need for sleep, and psychomotor agitation. The concept of unipolar mania was first proposed in the 19th century by Baillarger, Falret, and Grinsinger. However, it was German psychiatrist Emil Krapelin who was the first to explore the scope of manic-depressive illness, a discovery that ultimately led to the disorder's inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM-3). Krapelin first used the term "cyclical mania" in 1889 to refer to patients who experienced recurrent manic episodes without depression.
Some years later, Carl Wernicke argued that mania and depression should be considered two different illnesses.
As research into bipolar disorder continues, many studies suggest that the condition may have a unique genetic basis. However, this has not yet been supported by specific experiments. Although research on unipolar disorder continues, it is still not recognized in the latest DSM-5. Over time, monopolar disorder became less of a viable diagnosis because of the variability in how it manifested among different patients. Currently, even patients who experience only manic symptoms without depressive symptoms are still usually diagnosed with bipolar I disorder.
Clinical featuresAlthough unipolar disorder is not recognized as a separate psychiatric disorder, research shows that its clinical features differ significantly from those of bipolar disorder. These differences include:
- Experience fewer depressive traits.
- Lack of diurnal variation in mood.
- Fewer comorbidities of hallucinations and anxiety disorders.
- Lower rates of suicidal thoughts or attempts.
- Less aggressive behavior.
- Features such as rapid cycling and cyclical mood changes are common features of bipolar disorder but are less common in unipolar mania.
However, people with unipolar mania are more likely to experience delusions, display formal thought disorder, and have a history of substance abuse, especially marijuana and amphetamines.
Prevalence and diagnostic criteria
Definitions of unipolar mania usually include the duration of the illness and the number of manic episodes a person has. However, there is a lack of clear understanding of the prevalence of this condition. Differences among researchers in definitions and diagnostic criteria have resulted in a wide range in the prevalence of unipolar mania, ranging from as low as 1.1% to as high as 65.3%. The most commonly used definition was that of Carlo Peris in 1966, who suggested that a person who had experienced at least one manic episode without any depressive episodes could be considered to have unipolar mania. Using this definition, the prevalence of the disorder among all bipolar hospitalizations came to 35.2%.
Socio-demographic characteristics
Most studies of bipolar disorder come from non-Western countries, but that doesn’t mean the disorder is more common in those countries. More cross-cultural research is needed to confirm this. For example, a cross-cultural study conducted in France and Tunisia found that the prevalence of unipolar mania was three times higher in Tunisia than in France. Behind this result, the researchers suggested that it might be related to local climate factors, but there is a lack of further support from relevant research.
Research Progress
Unipolar mania is considered an untested diagnosis and has attracted a great deal of research to investigate the symptom variability and phenomena of unipolar mania in different patients. Ongoing studies such as the 15-year follow-up study by Solomon et al. found that participants who were initially diagnosed with mania and without depressive symptoms did not show any major or minor symptoms of depression during the 15-year follow-up. This suggests that unipolar mania should be considered a separate diagnostic category from bipolar I disorder. Although the DSM-IV included the disorder in the category of bipolar I, its long-term effects were not recognized.
Criticisms
Currently, there is no effective explanation for the cause of unipolar mania, and therefore no targeted treatment. There is still a lot of doubt as to whether unipolar mania is separate from bipolar disorder. The researchers expressed multiple concerns about its diagnosis. The first was that the study may not have taken into account the patients' past history of depression. The second was that the follow-up time was too short, making it difficult to observe possible depressive symptoms in the future. In summary, the current research results are clearly controversial regarding the status of unipolar mania as an independent disorder, and future research will require more evidence to prove its effectiveness.
