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February 1973

The Stages of ManiaA Longitudinal Analysis of the Manic Episode

Author Affiliations

Bethesda, Md
From the Section on Psychiatry, Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, Md.

Arch Gen Psychiatry. 1973;28(2):221-228. doi:10.1001/archpsyc.1973.01750320053009

The progression of symptoms during an acute manic episode was studied retrospectively in 20 bipolar manic-depressive patients whose diagnosis was reconfirmed at follow-up. Three stages were delineated, the most severe of which was manifested by bizarre behavior, hallucinations, paranoia, and extreme dysphoria. Despite symptoms that might have otherwise prompted a diagnosis of schizophrenia, patients appeared clearly manic both earlier in the course and later as the episode was resolving.

The level of functioning was ascertained at follow-up and compared statistically with the level of psychotic disorganization during the acute manic episode; no relationship was found. The advantages of using a longitudinal view of a psychotic episode as a diagnostic tool is discussed.