Language
Country/Area
No result found
Why is unipolar mania still not recognized in the diagnostic manual of mental illness?
Unipolar mania is a condition in which only manic episodes occur without depressive symptoms. However, it is still not recognized as an independent diagnostic category in the latest Diagnostic Manual of Mental Disorders (DSM-5). Since the concept of bipolar disorder was first introduced in the 19th century, the medical community's understanding and definition of the disorder has been in constant flux.
Unipolar mania is a very specific condition that involves a patient having manic episodes without accompanying depression. The clinical features of this condition are significantly different from those of patients with typical bipolar disorder.
Historical background and diagnostic evolution
In the 1860s, many pioneers in psychiatry, such as French doctors Baillarger and Falret, began studying conditions related to bipolar disorder. The first was German psychiatrist Emil Kraepelin. Based on his description of "cyclic mania", it was developed into the Diagnostic and Statistical Manual of Mental Disorders (DSM) 1993 and included it in the definition of bipolar disorder.
However, with further research into unipolar mania, many experts have discovered that this symptom does not fully fit into the current classification of bipolar disorder and should have its own independent diagnostic criteria. Despite this, the DSM-5 statement does not recognize it as a diagnostic category, resulting in diagnostic difficulties for clinical psychiatrists.
Differences in clinical features
Research points out that although there are some overlapping characteristics between unipolar mania and bipolar disorder, there are significant differences in the clinical manifestations of the two.
People with unipolar mania are less likely to experience symptoms such as depressed mood, daytime mood changes, hallucinations, and accompanying anxiety disorders, but they are more likely to experience delusions, thought disorders, and substance abuse.
In particular, patients with unipolar mania often have episodes more frequently accompanied by symptoms of psychosis, and their need for mental health support when seeking medical care is higher. This phenomenon raises the issue of ongoing controversy over existing diagnostic criteria.
Epidemiology and diagnostic criteria
Conclusions from epidemiological studies of unipolar mania are mixed because definitions and criteria for this diagnosis vary. In some studies, the prevalence of unipolar mania has been estimated to range from 1.1% to 65.3%. In 1966, Carlo Perris's definition of unipolar mania is often cited, and it is believed that only at least one manic episode without a depressive episode can be diagnosed.
Social demographic characteristics
Most research on unipolar mania comes from non-Western countries, which does not mean the disorder is more common in those countries. More cross-cultural research support is also needed for cultural differences. Studies in France and Tunisia, for example, show that the incidence of unipolar mania is higher in Tunisia, but there is still a lack of evidence on the link.
Research Trends
With the in-depth discussion of unipolar mania, especially in long-term follow-up studies, more and more studies have confirmed its rationality as an independent diagnosis. A study by Solomon et al. found that during a 15-year follow-up, manic patients who were initially labeled as having no depressive mood also did not show any tendency to be depressed in the later period.
In addition, recent case studies have shown that patients with unipolar mania, excluding other factors, present clinical manifestations that are significantly different from those of bipolar disorder, such as more intense symptoms.
Conclusion
Currently, the cause of unipolar mania cannot be directly determined, and there is no clear treatment. As symptom variability continues to be studied, experts are questioning the diagnostic validity of unipolar mania. Varying diagnostic criteria, research methods, and sample sizes make the independence of unipolar mania questionable. These questions reflect that the medical community has not yet reached a consensus on the understanding of unipolar mania, but exploration again and again may bring us closer to understanding this complex phenomenon. Can such a situation achieve breakthrough progress in the future?
