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Manic and Bipolar Syndromes

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Neuropsychodynamic Psychiatry

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Abstract

Patients with bipolar disorders show numerous neuropsychological impairments, not only during depressive and manic episodes but also after remission of symptoms. These dysfunctions are associated with structural and functional changes in cortical and limbic brain regions and have a profound impact on patients’ psychosocial functioning. This chapter gives an overview on relevant neuroscientific and neuropsychological findings in bipolar disorders. Furthermore, the personality structure and the interpersonal relationships of bipolar patients are taken into account.

In a neuropsychodynamic perspective, the hypernomic und ambiguity-intolerant behaviour of bipolar patients may be looked upon as an attempt to cope with an impending threat of a collapsing self-worth regulation and the shame which results from the experience of mania. In case of an instability of the self-image, a narcissistic slight or a disappointment (with an impairment of the ideal self) may induce a regression to the precursor stages of the ideal self (regressive activation of the grandiose self) or an actualization of other intrapsychic elements of the self-worth regulation and their precursors (e.g. complete submission to the claims of a rigid, rigorous superego). This may be interpreted as an attempt to cope with the narcissistic dysbalance and the danger of a depressive reaction.

The conceptualization of manic symptoms as mood modulators has important implications for the understanding and treatment of mania. The confrontation with the “temptation of mania” is of fundamental importance in the treatment of mania. The effectiveness of the drug treatment and the compliance of the patients depend on their attitude to mania essentially. In this context mania may not only be comprehended as the experience of a fatal disorder but also as a condition which is intended and desired. The neuropsychodynamic view of manic symptoms as mood modulators constitutes an important basis for the dialogue with the patients and provides them with a better understanding of their painful renunciation of the manic sense of euphoria.

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Authors and Affiliations

  1. Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Heinz Boeker

  2. Charité, Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Berlin, Germany

    Simone Grimm

  3. Department of Psychiatry, Psychotherapy, Psychosomatics, General Hospital of Frankfurt am Main, Teaching Hospital University Frankfurt, Frankfurt, Germany

    Peter Hartwich

  4. Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada

    Georg Northoff

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  1. Heinz Boeker
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  2. Simone Grimm
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  3. Peter Hartwich
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  4. Georg Northoff
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Correspondence to Heinz Boeker .

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Editors and Affiliations

  1. Psychiatric University Hospital Zurich, Zurich, Switzerland

    Heinz Boeker

  2. Hospital of Psychiatry-Psychotherapy-Psychosomatic, General Hospital Frankfurt, Teaching Hospital of the University, Frankfurt, Germany

    Peter Hartwich

  3. Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada

    Georg Northoff

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Boeker, H., Grimm, S., Hartwich, P., Northoff, G. (2018). Manic and Bipolar Syndromes. In: Boeker, H., Hartwich, P., Northoff, G. (eds) Neuropsychodynamic Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-75112-2_12

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  • DOI: https://doi.org/10.1007/978-3-319-75112-2_12

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