Sixty years of recurrence prevention in mood disorders. / Szescdziesiat lat profilaktyki nawrotów chorób afektywnych.

This year, we observe sixty's anniversary of the article by a British psychiatrist, Geoffrey Hartigan, demonstrating, for the first time, the possibility of preventing of the recurrence of mood disorders by using lithium salts. Herein, a history of prevention of recurrences of mood disorders both worldwide and in Poland will be presented concerning both lithium and other mood-stabilizing drugs. The merit for verifying the prophylactic lithium effect in the 1960-1970s should be given to Danish researchers, Mogens Schou and Poul Baastrup. In Poland, the first paper on prophylactic lithium appeared already in 1971. In the 1970s, French researchers showed prophylactic activity of valproic acid amide, and Japanese researchers - carbamazepine. In the 1980th, studies on valproic acid amide were performed in the 2nd Psychiatric Clinic of the Institute of Psychiatry and Neurology led by Prof. Puzynski. Since the mid-1990s, 2nd generation of mood-stabilizing drugs has been introduced, including some atypical antipsychotics (clozapine, olanzapine, quetiapine, aripiprazole, risperidone) and anticonvulsant drug, lamotrigine, showing prophylactic activity in bipolar mood disorder. The studies on lithium resulted in the identification of factors connected with its prophylactic efficacy as well as the antisuicidal, antiviral, and neuroprotective effects of this drug. From a sixty-year perspective following Hartigan's article, it seems that his pioneering concept on the possibility of pharmacological influence on the course of mood disorders was fully confirmed. Current Polish recommendations on pharmacological prophylaxis of mood disorders were presented in the books "Standardy leczenia niektórych zaburzen psychicznych" and "Psychofarmakologia kliniczna", both published in 2022.

Campbell's 1953 Book on "Manic-Depressive Disease": A Counter-Factual History of the DSM Symptomatic "A Criteria" for Major Depression.

ABSTRACT: The DSM-III symptomatic criteria for major depression (MD) were derived from those proposed by Feighner and colleagues in 1972, which closely resembled those published by Cassidy in 1957. I here present a counter-factual history in which Feighner carefully read a key reference in Cassidy, a large 1953 follow-up study by Campbell of depressed patients with detailed tables of depressive signs and symptoms. In this alternative timeline, the Feighner criteria for MD were modified by Campbell's results, which then changed DSM-III and subsequent MD criteria sets. The historical pathway to the current DSM MD criteria was contingent on a range of historical events and could easily have been different. This story is not meant to criticize DSM MD criteria that perform well. Rather, it suggests that these criteria represent a useful but fallible set of symptoms/signs that index but do not constitute MD and therefore are not to be reified.

Unitary psychosis (Einheitspsychose): A conceptual history.

AIMS: The objective of this paper is to explore the evolution of the forms of madness and the model that accounts for it over time. The classical distinction between several categories of mental disorders is contrasted with the idea of unitary psychosis. METHODS: Historical conceptual analysis. The concept of unitary psychosis is explored in its basic features. Its origins in the nineteenth century and developments during the twentieth century are considered. RESULTS: Following the publication of Kraepelin's fundamental handbook, the debate was shaped as pro or against the Kraepelinian dichotomy between dementia praecox and manic-depressive illness. However, the origins of the concept of unitary psychosis as well as some more recent developments are independent from it. CONCLUSIONS: This article argues that, when viewed pragmatically, both positions (the pluralist and the unitary) bring advantages that can be complementary rather than mutually exclusive. The pluralist position allows us to recognize the qualitative differences between phenomena and structures of experience, while the unitary model prevents us from reifying them. This is achieved by paying attention to the diachronic evolution and the pathogenetic dynamics.

Consanguinidad y enfermedad mental grave en los primeros Borbones españoles / Inbreeding and serious mental illness in the first Spanish Bourbons

INTRODUCCIÓN: Se discute si la consanguinidad es un factor de riesgo para sufrir trastorno bipolar o esquizofrenia. Los árboles genealógicos de las casas reales son una oportunidad para estudiarlo. Felipe V posiblemente sufrió un trastorno mental grave, como también su hijo Fernando VI. Sin embargo, Carlos III, también hijo de Felipe V, pero fruto de otro matrimonio, aparentemente no. Se mantiene la hipótesis de que la consanguinidad podría haber sido un factor de riesgo para ello. SUJETOS Y MÉTODOS: Se analizan las biografías de estos tres reyes para detectar si sufrieron algún trastorno mental de acuerdo con el DSM-5 y la CIE-11. Se estudia su coeficiente de consanguinidad mediante el programa PedPro con una base de datos de 25.776 individuos. RESULTADOS: Felipe V y Fernando VI podrían haber sido diagnosticados de trastorno bipolar, mientras que Carlos III podría haberlo sido de un leve trastorno de la personalidad. Felipe V y Fernando VI tenían un coeficiente de consanguinidad elevado (0,091109 y 0,095023, respectivamente), mientras que en Carlos III era sólo de 0,038264. El coeficiente de los dos primeros es mayor que el de los hijos de primos hermanos (0,0625). CONCLUSIONES: Felipe V y Fernando VI sufrieron un trastorno bipolar. El análisis de los árboles genéticos mediante el coeficiente de consanguinidad es una valiosa herramienta para el estudio de la heredabilidad del trastorno bipolar. La endogamia acumula alelos patógenos y el riesgo de sufrirlo. En estos sujetos, la alta consanguinidad fue un importante factor etiopatogénico de la enfermedad que sufrieron. Una elevada consanguinidad supone un factor de riesgo de sufrir trastorno bipolar

INTRODUCTION: There is an argument about inbreeding as a risk factor in the development of major mental illnesses like bipolar disorder or schizophrenia. The genealogical trees of European royal dynasties represent an opportunity to study this relationship. Felipe V was the first Bourbon king to rule in Spain, who was thought to have possibly suffered a severe mental disorder. Felipe's son Fernando VI, also had a mental disease. Nevertheless Carlos III, Felipe V's son born from a different, unrelated mother, apparently showed no trace of such disorder. We hypothesize that consanguinity or inbreeding could explain the tendency in the acquiring of severe mental disorders. SUBJECTS AND METHODS: Biographies of three Spanish Bourbon kings (Felipe V, Fernando VI and Carlos III) were analysed in order to evaluate if they were likely to have suffered from some mental disorder, according to DSM-5 and ICD-11 criteria. An inbreeding coefficient was determined with the PedPro Program. RESULTS: Felipe V and Fernando VI could have been diagnosed with bipolar disorder, whereas Carlos III could have been diagnosed with a mild personality disorder. Both Felipe V and Fernando VI had a high inbreeding coefficient (0.091109 and 0.095023, respectively), while Carlos III had a lower one (0.038264). The inbreeding coefficient of siblings of couples of first grade cousins is 0.0625. CONCLUSIONS: A high inbreeding coefficient is a risk factor in developing bipolar disorder. Felipe V and Fernando VI suffered from bipolar disorder. The analysis of genetic trees by the inbreeding coefficient is a valuable tool in the study of heredability of bipolar disorder. Endogamy accumulates pathogenic alleles and increases risk to suffer it. These kings had a high consanguinity which was an important risk factor to the illness. High consanguinity is a risk factor to suffer bipolar disorder

Virginia Woolf, neuroprogression, and bipolar disorder

Family history and traumatic experiences are factors linked to bipolar disorder. It is known that the lifetime risk of bipolar disorder in relatives of a bipolar proband are 5-10% for first degree relatives and 40-70% for monozygotic co-twins. It is also known that patients with early childhood trauma present earlier onset of bipolar disorder, increased number of manic episodes, and more suicide attempts. We have recently reported that childhood trauma partly mediates the effect of family history on bipolar disorder diagnosis. In light of these findings from the scientific literature, we reviewed the work of British writer Virginia Woolf, who allegedly suffered from bipolar disorder. Her disorder was strongly related to her family background. Moreover, Virginia Woolf was sexually molested by her half siblings for nine years. Her bipolar disorder symptoms presented a pernicious course, associated with hospitalizations, suicidal behavioral, and functional impairment. The concept of neuroprogression has been used to explain the clinical deterioration that takes places in a subgroup of bipolar disorder patients. The examination of Virgina Woolf’s biography and art can provide clinicians with important insights about the course of bipolar disorder.

Kraepelin's description of chronic mania: a clinical picture that meets the behavioral variant frontotemporal dementia phenotype / A descrição de Kraepelin de mania crônica: um quadro clínico que corresponde ao fenótipo da variante comportamental da demência fronto-temporal

ABSTRACT Chronic mania is an under-investigated condition and few reports have associated this disorder with an organic background. The present work examines Kraepelin’s reliable description of chronic mania from a current behavioral neurology viewpoint. Kraepelin had described a cluster of symptoms that are now recognized as core manifestations of the behavioral variant frontotemporal dementia (bvFTD) clinical phenotype. We also carried out additional reviews of original manuscripts from Kraepelin’s peers, in order to find any case reports that might fulfill the current diagnostic proposal for bvFTD. Even though we failed to find an ideal case, we found some scholars who seemed to agree that chronic mania should be considered a special form of dementia. The present work highlights, through historical data, the possible overlapping features between primary psychiatric disorders and neuropsychiatric symptoms secondary to neurodegenerative conditions.

RESUMO A mania crônica constitui uma condição subinvestigada e alguns trabalhos têm associado esta desordem a um substrato orgânico. O presente manuscrito analisa a descrição fidedigna de Kraepelin de mania crônica a partir de um ponto de vista atual da neurologia comportamental. Concebemos que ele havia descrito um conjunto de sintomas que atualmente é reconhecido como manifestações centrais do fenótipo clínico da variante comportamental da demência frontotemporal (bvFTD). Também realizamos uma revisão adicional de manuscritos originais de pares contemporâneos de Kraepelin, a fim de procurar por um único relato de caso que poderia preencher critério diagnóstico atual de bvFTD. Mesmo que não tenhamos conseguido encontrar um caso perfeitamente exemplar, identificamos que alguns estudiosos da época pareciam concordar que a mania crônica devesse ser considerada uma forma especial de demência. O presente trabalho destaca por meio de dados históricos a sobreposição entre transtornos psiquiátricos primários e sintomas neuropsiquiátricos secundários a doenças neurodegenerativas.

La demencia del rey Fernando VI y el año sin rey / The dementia of King Ferdinand VI and the year with no king

Introducción. Fernando VI fue rey de España entre 1746 y 1759. Su último año de reinado se conoce como el año sin rey. Durante ese año, el monarca sufrió un rápido empeoramiento de sus condiciones mentales. La enfermedad generalmente ha sido atribuida a una condición psiquiátrica primaria, generalmente por un trastorno bipolar. Desarrollo. Se realiza un estudio de investigación en los archivos documentales españoles y bibliotecas en busca de información clínica sobre la enfermedad de Fernando VI. Se realiza una evaluación y discusión clínica de la enfermedad del rey sobre la base de la información obtenida. Conclusiones. El inicio del empeoramiento clínico del último año de Fernando VI empezó tras la muerte de su amada esposa. Los síntomas iniciales descritos pueden ser similares a los de un episodio depresivo mayor, sin embargo, el monarca sufrió un empeoramiento rápidamente progresivo con alteraciones de la personalidad, conductuales, encamamiento, pérdida de control de esfínteres y crisis epilépticas. Los últimos meses de su vida estuvo en un estado de postración con un estado cognitivo compatible con una demencia grave. Por todo ello, aunque es posible que Fernando VI pudiera padecer previamente algún tipo de trastorno psiquiátrico, la enfermedad que le llevó a su muerte precoz sería compatible con lo que hoy conocemos como una demencia rápidamente progresiva (AU)

Introduction. Ferdinand VI was king of Spain from 1746 until 1759. His last year of reign is known as the year without a king. Over this year the king suffered a rapidly progressive deterioration of his mental health status. The clinical condition has been always attributed to a pure psychiatric disorder, generally a bipolar disorder. Development. We review the sources of information in the Spanish archives and libraries, in order to find clinical information about the illness suffered by the king. We made a clinical evaluation and discussion about the disease of the king according to the information that has been obtained and the different diseases that could have caused the illness. Conclusions. Last year clinical deterioration of Ferdinand VI started with the death of his lovely wife. At first, the symptoms were similar to the symptoms of a mayor depressive disorder. Although the king had a rapidly progressive deterioration with severe changes in behavior and conduct, long stay in bed, loss of sphincters control and seizures. During the last months of his life, the king fell into a state of prostration with a marked cognitive impairment. Although it is possible that Ferdinand VI could have had a previous psychiatric disorder, there is enough information to think about a rapidly progressive dementia as the main cause of his clinical worsening and dead (AU)

Melancolia e depressão durante o século XIX: uma história conceitual / Melancholia and depression during the 19th Century: a conceptual history / Mélancolie et dépression au cours du XIX siècle: une histoire conceptuelle / Melancolía y depresión durante el siglo XIX: uma historia conceptual

Este artigo analisa historicamente o background ideológico que tornou possível a transformação da noção de melancolia nos conceitos de depressão e transtorno bipolar, a partir das mudanças médicas e psicológicas ocorridas no decorrer do século XIX. A antiga noção de melancolia foi remodelada e sua transição para a doença depressiva foi facilitada pelo conceito de Iipemania de Esquirol, que, pela primeira vez, enfatizou a natureza afetiva primária da doença. Finalmente, uma vez obtidas as condições conceituais necessárias, a melancolia e a mania foram combinadas no conceito de insanidade alternante, periódica, circular, ou de forma dupla, seus rígidos padrões descritivos foram flexibilizados, tendo culminado este processo na sinopse de Kraepelin.(AU)

This article historically examines the ideological background that opened the way to the transformation of the notion of melancholia into the concepts of depression and bipolar disorder, based on changes in medicine and psychology during the 19th century. The older notion of melancholia was remodeled and its transition to the concept of depression disorder was facilitated by the concept of lipemania, introduced by Esquirol, who first emphasized the primarily affective nature of the disease. Finally, once the necessary conceptual conditions had been attained, melancholia and mania were merged into the concept of periodic, circular and alternating (or even simultaneous) insanity. Consequently, its strict descriptive standards were relaxed, culminating in Kraepelin's synopsis.(AU)

Cet article examine du point de vue historique le contexte idéologique qui a permit la transformation de la notion de mélancolie en concepts de dépression et de trouble bipolaire à partir de l'évolution médicale et psychologique qui a eu lieu au cours du XIX siècle. L'ancienne notion de mélancolie est révisée et sa transformation en notion de maladie dépressive s'opère entre autre grâce au concept de lypémanie d'Esquirol qui a été le premier à souligner le caractère affectif primaire de la maladie. Les conditions conceptuelles nécessaires établies, la mélancolie et la manie sont transformées en concept de la folie alternante, périodique, circulaire, ou double. Ses normes descriptives rigides sont assouplies, ce qui finalement abouti à la synthèse de Kraepelin.(AU)

Este artículo analiza históricamente el background ideológico que hizo posible la transformación de la noción de melancolía en los conceptos de depresión y trastorno bipolar, a partir de los cambios médicos y psicológicos ocurridos en el decorrer del siglo XIX. La noción antigua de melancolía fue remodelada y su transición para la enfermedad depresiva fue facilitada por el concepto de lipemania de Esquirol, quien, por primera vez, enfatizó la naturaleza afectiva primaria de la enfermedad. Finalmente, obtenidas las condiciones conceptuales necesarias, la melancolía y la manía fueron combinadas en el concepto de insanidad alternante, periódica, circular, o de forma dupla, sus patrones rígidos descriptivos fueron flexibilizados, culminando este proceso en la sinopsis de Kraepelin.(AU)

Melancolia e depressão durante o século XIX: uma história conceitual / Melancholia and depression during the 19th Century: a conceptual history / Mélancolie et dépression au cours du XIX siècle: une histoire conceptuelle / Melancolía y depresión durante el siglo XIX: uma historia conceptual

Este artigo analisa historicamente o background ideológico que tornou possível a transformação da noção de melancolia nos conceitos de depressão e transtorno bipolar, a partir das mudanças médicas e psicológicas ocorridas no decorrer do século XIX. A antiga noção de melancolia foi remodelada e sua transição para a doença depressiva foi facilitada pelo conceito de Iipemania de Esquirol, que, pela primeira vez, enfatizou a natureza afetiva primária da doença. Finalmente, uma vez obtidas as condições conceituais necessárias, a melancolia e a mania foram combinadas no conceito de insanidade alternante, periódica, circular, ou de forma dupla, seus rígidos padrões descritivos foram flexibilizados, tendo culminado este processo na sinopse de Kraepelin.

This article historically examines the ideological background that opened the way to the transformation of the notion of melancholia into the concepts of depression and bipolar disorder, based on changes in medicine and psychology during the 19th century. The older notion of melancholia was remodeled and its transition to the concept of depression disorder was facilitated by the concept of lipemania, introduced by Esquirol, who first emphasized the primarily affective nature of the disease. Finally, once the necessary conceptual conditions had been attained, melancholia and mania were merged into the concept of periodic, circular and alternating (or even simultaneous) insanity. Consequently, its strict descriptive standards were relaxed, culminating in Kraepelin's synopsis.

Cet article examine du point de vue historique le contexte idéologique qui a permit la transformation de la notion de mélancolie en concepts de dépression et de trouble bipolaire à partir de l'évolution médicale et psychologique qui a eu lieu au cours du XIX siècle. L'ancienne notion de mélancolie est révisée et sa transformation en notion de maladie dépressive s'opère entre autre grâce au concept de lypémanie d'Esquirol qui a été le premier à souligner le caractère affectif primaire de la maladie. Les conditions conceptuelles nécessaires établies, la mélancolie et la manie sont transformées en concept de la folie alternante, périodique, circulaire, ou double. Ses normes descriptives rigides sont assouplies, ce qui finalement abouti à la synthèse de Kraepelin.

Este artículo analiza históricamente el background ideológico que hizo posible la transformación de la noción de melancolía en los conceptos de depresión y trastorno bipolar, a partir de los cambios médicos y psicológicos ocurridos en el decorrer del siglo XIX. La noción antigua de melancolía fue remodelada y su transición para la enfermedad depresiva fue facilitada por el concepto de lipemania de Esquirol, quien, por primera vez, enfatizó la naturaleza afectiva primaria de la enfermedad. Finalmente, obtenidas las condiciones conceptuales necesarias, la melancolía y la manía fueron combinadas en el concepto de insanidad alternante, periódica, circular, o de forma dupla, sus patrones rígidos descriptivos fueron flexibilizados, culminando este proceso en la sinopsis de Kraepelin.

Sobre el diagnóstico de bipolaridad / Diagnosing bipolar disorder

Dado el aumento en el diagnostico de bipolaridad, las dificultades de establecer límites entre el ánimo normal y patológico y los riesgos derivados de la indicación de tratamientos inadecuados se presentan aquí antecedentes relativos a la historia y diagnóstico del Trastorno Bipolar así como las principales clasificaciones vigentes y las áreas de conflicto en cuanto a diagnóstico diferencial.

Given the increase diagnosis of bipolarity nowadays, the difficult to clarify the border between normal and pathological mood in this article the historical aspects and clinical features of Bipolar Disorder are reviewed as well as the differential diagnosis.

Diferencias terapéuticas de los medicamentos para el tratamiento de los trastornos bipolares: siete años después / Therapeutic and Pharmacologic Differences between Medications Used in the Treatment of Bipolar Disorders: Seven-Year Update

En el 2004 fue publicada una revisión detallada sobre las características terapéuticas de los medicamentos utilizados en el tratamiento de los trastornos bipolares [Tamayo JM et al. Actas Esp Psiquiatr 2004; 32 (Supl. 1): 3-17]. En aquél momento se podía concluir que si bien los eutimizantes compartían algunos mecanismos de acción, eran a la vez sustancialmente diferentes respecto a sus propiedades terapéuticas en las diferentes fases de los trastornos bipolares llevando a proponer un cambio en su clasificación genérica como “estabilizadores del estado de ánimo” a una nueva incluyendo: antimaníacos, estabilizadores parciales del ánimo y eutimizantes. Desde entonces, han sido publicados varios estudios doble-ciego aleatorizados y meta-análisis, explorando la eficacia y tolerabilidad de estos medicamentos. Esta revisión actualizada pretende evaluar, a la luz de la nueva evidencia, la validez de la propuesta de clasificación publicada en ese entonces (AU)

A detailed review was published in 2004 on the therapeutic properties of the medications used in the treatment of bipolar disorders (Tamayo, JM et al. Actas Esp Psiquiatr 2004; 32 (Suppl. 1): 3-17). At the time it could be concluded that although mood stabilizers (euthymics) share some action mechanisms, they are also significantly different from each other with respect to their therapeutic properties in the various phases of bipolar disorders. This led to a proposed change in their generic classification as “mood stabilizers” to a new classification that includes: antimanic medications, partial mood stabilizers, and euthymics. Since then, several randomized, double-blind studies and meta-analyses that explore the effectiveness and tolerability of these medications have been published. This updated review aims to assess the validity of the proposed classification in the light of new evidence (AU)

A cena constituinte da psicose maníaco-depressiva no Brasil / The emergence of manic depressive psychosis as a diagnosis in Brazil

A intenção deste ensaio é esboçar a leitura da psicose maníaco-depressiva no Brasil, no começo do século XX. Destaca a transformação teórica ocorrida na psiquiatria brasileira, que se deslocou da tradição francesa para a alemã. Sublinha o modo como a problemática da histeria foi substituída pela da psicose maníaco-depressiva nesse contexto histórico.

This essay examines the early twentieth-century interpretation of manic depressive psychosis in Brazil, during a moment when Brazilian psychiatry witnessed a theoretical shift from the French to German traditions. It calls special attention to how the problem of hysteria was replaced by manic depressive psychosis within this historical context.

A evolução histórica dos conceitos de transtorno de humor e transtorno de personalidade: problemas no diagnóstico diferencial: [revisão] / Historical evolution of mood disorders and personality disorders concepts: difficulties in the differential diagnostic: [review]

CONTEXTO: Os conceitos de transtornos de humor e de personalidade sofreram diversas mudanças nas últimas décadas. Historicamente, esses conceitos foram construídos em paralelo, isto é, transtornos de humor e personalidade são considerados como transtornos independentes em relação ao diagnóstico, ao prognóstico e ao tratamento. Recentemente, entretanto, novas propostas na conceituação nosológica desses transtornos levantaram a questão de uma possível sobreposição dessas entidades, tornando o diagnóstico diferencial entre esses transtornos muitas vezes difícil. OBJETIVOS: Realizar uma revisão de literatura sobre a evolução dos conceitos de transtorno de humor e personalidade sob uma perspectiva histórica, focando em publicações relacionadas ao diagnóstico. MÉTODO: Revisão compreensiva da literatura utilizando o banco de dados MEDLINE (1990-2007). RESULTADOS: Ao contrário do conceito de transtorno de humor, que se apresenta estável e relativamente sem modificações desde suas primeiras descrições, o conceito de transtorno de personalidade mostra considerável variação ao longo dos diferentes achados de literatura. Assim, ambos os grupos de transtornos têm sido conceituados tanto categorial como dimensionalmente. Esta última abordagem pode ser, em parte, responsável pelas dificuldades algumas vezes encontradas no diagnóstico diferencial desses transtornos. CONCLUSÃO: O diagnóstico diferencial entre transtornos de humor e personalidade ainda representa um sério problema na prática clínica e não pode ser completamente esclarecido com base nas evidências disponíveis. O melhor entendimento da base fisiopatológica desses transtornos, bem como a identificação mais precisa de seus marcadores biológicos, pode ajudar a redefinir seus conceitos e seus status nosológicos atuais.

BACKGROUND: The concepts of mood and personality disorders have faced countless changes over the last decades. Historically, these concepts have been built in parallel, that is, mood and personality disorders have been considered as independent disorders with respect to diagnosis, prognosis and treatment. Recently, however, new proposes on the nosological conceptualization of these disorders have raised the question of a possible overlap between these nosological entities, making the differential diagnosis between these disorders difficult at times. OBJECTIVES: To carry out a literature review on the evolution of mood and personality disorders concepts under a historical perspective, focusing on diagnostic-related issues. METHOD: A comprehensive MEDLINE literature search (1990-2007) was conducted. RESULTS: Contrarily to the concept of mood disorder, which seems to be stable and relatively unchanged since its first description, the concept of personality disorder shows considerable variation over the different literature findings. Thus, both groups of disorders have been conceptualized not only in a categorical point of view but also according to a dimensional approach. The last one may be at least partially accountable for the difficulties sometimes observed in the differential diagnosis of these disorders. DISCUSSION: The differential diagnosis between mood and personality disorders may still represent a serious problem in clinical settings, and can not be completely clarified in light of available evidence. A better understanding of the pathophysiological basis of these disorders, as well as the more accurate identification of their biological markers can help redefining their concepts and their nosological current status.

Relaciones entre el trastorno límite de personalidad y el espectro bipolar: [revisión] / Relationship between borderline personality disorder and bipolar spectrum: [review]

Existe una controversia respecto a la independencia nosológica del trastorno límite de personalidad. Algunos autores sostienen que es parte del trastorno bipolar, mientras otros afirman que es una entidad independiente. En este trabajo se analiza la evolución histórica de los conceptos de trastorno límite y trastorno bipolar. Se discuten los argumentos a favor y en contra de incluir el trastorno límite dentro del trastorno bipolar. Por último se proponen nuevas estrategias para abordar este problema.

The independent nosological status of borderline personality disorder is a controversial issue. Some authors consider borderline as part of bipolar spectrum, but other sustain that is a independent entity. The historical evolution of borderline personality disorder and bipolar disorder is analyzed in this work. The arguments for include, or not include, borderline personality disorder in bipolar disorder is discussed. Finally, new strategies for study this problem are proposed.

Impacto funcional de los trastornos bipolares: altibajos históricos frente a un problema clave / Bipolar disorders functional impact. historical ups and downs in relation to a key problem

The way that the sanitary concept impacted the bipolar disorders has oscillated noticeably in the last years. At the beginning of the XX century they were considered a fundamental part of the structure of clinical psychiatry, disabling and more frequent then schizophrenias. Concomitantly to the insertion of the use of the antiseptics in the fifties they start to enter the shadows of the interest of clinicians and investigators at the same time that the concept of them is changed understanding that in the majority of cases they are benign and with little functional impact. In the last twenty years this situation changes yet again getting more attention and rediscovering that more then half of the people affected by it suffer a strong functional impact. None the less, in this conceptual back and forth, the enormous heterogeneity that these cases have has been lost which permit that an appreciable percentage of affected people have an optimal performance or even above average. In this article we explore the conceptual alternatives and also some models that take into account this heterogenety.

El modo en que se conceptuó el impacto sanitario de los Trastornos Bipolares ha oscilado llamativamente en los últimos años. A principio del siglo XX eran considerados parte fundamental de la estructura clínica psiquiátrica, disabilitantes y más frecuentes que las esquizofrenias. Concomitantemente a la inserción del uso de los antipsicóticos en la década del 50 comienzan a entrar en un cono de sombra en el interés de clínicos e investigadores al mismo tiempo que se cambia el concepto sobre ellos al entenderse de que en la mayoría de los casos se trata de cuadros benignos y con poco impacto funcional. En los últimos 20 años esta situación vuelve a cambiar al prestársele más atención a estos cuadros y redescubrir el hecho de que más de la mitad de las personas afectadas por ellos sufren un fuerte impacto funcional. Sin embargo, en este vaivén conceptual se ha ido perdiendo de vista la enorme heterogeneidad que tienen estos cuadros la cual permite que un porcentaje nada despreciable de personas afectadas tengan un rendimiento óptimo o incluso mayor al de la media. En este artículo se revisan estas alternancias conceptuales y se revisan algunos modelos que tienen en cuenta esta heterogeneidad.