Skip to main content
Log in

The course of affective disorders

II. Typology of bipolar manic-depressive illness

  • Published:
Archiv für Psychiatrie und Nervenkrankheiten Aims and scope Submit manuscript


A representative sample of 95 hospitalized bipolar manic-depressive patients was followed up from 1959 to 1975. The mean age of the group at the time of this study was 61 years. It was observed that female bipolar patients demonstrate depression much more frequently than mania, while male patients show a symmetric distribution of both manic and depressive syndromes. The longitudinal occurrence of syndromes remains more or less constant; for instance, individual patients do not tend to go into depression with increasing age. The study shows that even after three episodes 29% of all bipolar patients would still have been misdiagnosed as unipolar depression.

An attempt is made to classify bipolar patients into three subtypes, ‘preponderantly manic,’ ‘preponderantly depressed,’ and a ‘nuclear’ type. Male patients belong mainly to the latter with an equal proportion of the first and third subtype. In contrast, female patients belong mainly to the depressed subtype.

The findings are discussed assuming either a heterogeneity of bipolar disorders or a threshold model of affective disorders suggested by Gershon et al. (1976).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  • Angst, J.: Zur Aetiologie und Nosologie endogener depressiver Psychosen. Monogr. Gesamtgeb. Neurol. Psychiatr. Heft 112. Berlin-Heidelberg-New York: Springer 1966

    Google Scholar 

  • Angst, J.: The classification of affective psychoses. Lecture read at the Annual Meeting of The Royal College of Psychiatrists, 4th July, London 1974

  • Angst, J., Frey, R., Stassen, H. H.: The course of affective disorders. I. Change of diagnosis of monopolar, unipolar and bipolar illness. Arch. Psychiat. Nervenkr. 226, 57–64 (1978)

    Google Scholar 

  • Gershon, E. S., Bunney, W. E., Leckman, J. F., v. Eerdewegh, M., DeBauche, B. A.: The inheritance of affective disorders: A review of data and of hypotheses. Behav. Genet. 6, 227–261 (1976)

    Google Scholar 

  • Lee, H. K., Lee, B. Y.: The clinical study of manic depressive illness (Korean). Korea Univ. Med. J. 9, 139–151 (1972)

    Google Scholar 

  • Leonhard, K.: Aufteilung der endogenen Psychosen. Berlin: Akademie Verlag 1957

    Google Scholar 

  • Mendlewicz, J., Fleiss, J. L., Fieve, R. R.: Evidence for X-linkage in the transmission of manicdepressive illness. JAMA 222, 1624–1627 (1972)

    Google Scholar 

  • Perris, C.: A study of bipolar (manic-depressive) and unipolar recurrent depressive psychoses. Acta Psychiatr. Scand. [Suppl.] 194, 1–189 (1966)

    Google Scholar 

  • Taylor, M., Abrams, R.: Manic states. A genetic study of early and late onset of affective disorders. Arch. Gen. Psychiatry 28, 656–658 (1973)

    Google Scholar 

  • Winokur, G., Clayton, P., Reich, T.: Manic-depressive illness. St. Louis: Mosby 1969

    Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and permissions

About this article

Cite this article

Angst, J. The course of affective disorders. Arch. Psychiat. Nervenkr. 226, 65–73 (1978).

Download citation

  • Received:

  • Issue Date:

  • DOI:

Key words