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.