COMMENTARY

"Bipolarity" in the Setting of Dementia: Bipolar Type VI?

Hagop S. Akiskal, MD; Olavo Pinto, MD; Diogo R. Lara ,MD, PhD

Disclosures

January 06, 2005

In This Article

The Bipolar Spectrum

In a previous paper, bipolar prototypes I to IV have been described.[1] In a nutshell, this spectrum involves depression with varying degrees of excitatory signs and symptoms up to full-blown mania (prototype I), discrete hypomanic episodes (prototype II), hypomania associated with antidepressants and/or psychostimulants (prototype III), and hyperthymic temperament (prototype IV). In general, the "softer" the case, the later the onset of clinically observable mood disorder. Bipolar I is commonly manifested during teens and early adulthood, whereas prototype IV would present with depressive episodes around the fourth and fifth decades of life. There is also increasing evidence for a type V, characterized by recurrent depressions without discrete hypomania, but mixed hypomanic episodes (irritability/agitation/racing thoughts) during depression.[2]

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