Unipolar mania reconsidered evidence from a South African study

Abstract

OBJECTIVE : There is a lack of studies that examine prevalence and phenomenology of bipolar disorder in Africa. In literature, a unipolar manic course of illness in particular is reported to be rare. The purpose of this study was to investigate and describe the course of illness and clinical features for a cross-section of patients diagnosed with bipolar disorder attending public hospitals in Limpopo Province, South Africa and to determine the rate of a unipolar manic course in this sample of patients. METHOD : This was a descriptive, cross-sectional study of patients presenting with a history of mania between October 2009 and April 2010, to three hospitals in Limpopo Province. A purposeful sample of 103 patients was recruited and interviewed using the Affective Disorders Evaluation. RESULTS : This study confirms that a unipolar manic course is indeed much more common than occurrences suggested in present day literature, with 57% of the study sample ever experiencing manic episodes. Patients presenting with a unipolar manic course of illness, as described in this study, may contribute to the search for an etiologically homogeneous sub-group, which presents a unique phenotype for genetic research and the search for genetic markers in mental illness. With a view to future research, a unipolar manic course therefore needs to be considered as a specifier in diagnostic systems in order to increase the awareness of such a course of illness in bipolar disorder. CONCLUSION : Fifty seven percent (57%) of study subjects had only ever experienced manic episodes, which is in keeping with findings from Africa and other non-Western countries. Identifying etiologically homogenous subgroups in psychiatry can also aid the profession in developing a reliable and valid nosology for psychiatric disorders. We need to consider a unipolar manic course at least a specifier in DSM and ICD.