Unipolar Mania: Recent Updates and Review of the Literature

Abstract

Introduction. Unipolar mania (UM) has received less than the expected attention, when compared to its contemporary mood disorders, unipolar depression (UD) and bipolar disorder (BD). Method. The literature search included PUBMED and PSYCINFO databases. Cross-searches of key references were made to identify other articles of importance. Results. There seems to be a bipolar subgroup with a stable, unipolar recurrent manic course. Although UM does not have significant differences from bipolar mania in terms of sociodemographic variables, there are certain significant differences in clinical features. UM is reported to have more grandiosity, psychotic symptoms, and premorbid hyperthymic temperament, but less rapid cycling, suicidality, seasonality, and comorbid anxiety disorders. It seems to have a better course of illness with better social and professional adjustment. However, its response to lithium prophylaxis is found to be poor as compared to classical BD and valproate could be a better choice in this case. Conclusion. The available literature suggests that UM has certain differences from classical BD. The evidence, however, is insufficient to categorize it as separate diagnostic entity. However, considering UM as a course specifier of BD would be a reasonable step.

Differences between unipolar mania and bipolar‐I disorder: Evidence from nine epidemiological studies

“…This difference was even more pronounced in the two adolescent studies (5.6% vs 22.0%). This is in agreement with a long‐term follow‐up study of a sample of hospital admissions in Zurich, with the study of Grobler et al, with the reviews of Yazici and Mehta as well as with the recent finding of Amamou et al in Tunisia . Our observation of a lower proportion of bulimia/binge eating disorders among adults with unipolar mania than among those with BP‐I disorder is a new finding.…”

“…Our finding that unipolar mania in both adults and adolescents is significantly less strongly associated than BP‐I disorder with GAD and panic disorders confirms the results of Merikangas et al in adolescents and of Baek et al in adults . It also corroborates three earlier reviews of clinical studies and the clinical studies of Andrade‐Nascimento et al and of Grobler et al…”

“…From a clinical perspective, there is strong evidence that some patients suffer from pure unipolar mania or mania with mild (not major) depression although it is relatively rare. Notable differences between unipolar mania and BP‐I disorder have been reported in literature reviews and single studies on mania, including a more frequent premorbid hyperthymic temperament, less suicidality, a lower likelihood of developing comorbid anxiety disorders, more psychotic features, and more cannabis abuse for subjects with unipolar mania. In addition, with some exceptions, there is evidence that individuals with pure mania are less likely to have a positive family history for major depressive disorder (MDD) and family studies have found evidence for independent familial aggregation of manic and depressive episodes …”

Bipolar disorder in Asia: Illness course and contributing factors

“…Further, various non-Western countries (especially those in the tropical regions) report a higher prevalence of manic PP (Lee and Yu, 1994;Makanjuola, 1985;Mehta, 2014). The observations are in sharp contrast from the West where prospective studies were able to document more depressive symptoms (Bopp et al, 2010;Forte et al, 2015;Judd et al, 2002;Strakowski et al, 2007).…”

Unipolar mania: Identification and characterisation of cases in France and the United Kingdom

“…Investigating the clinical characteristics of people with unipolar mania is also important as they may have different care needs and risk profiles compared to people with bipolar disorder who also experience depressive episodes. The concept of unipolar mania dates back to Kraepelin (Mehta, 2014) although in modern diagnostic criteria unipolar mania is conceptualised as a subtype of bipolar I disorder (DSM-5) or as bipolar type I disorder, unspecified . Perhaps because of the lack of a distinct diagnostic category, there has been a little research into unipolar mania particularly in urban populations in developed countries.…”