Unipolar Mania: A Particular Aspect of Bipolar Disorder in Tunisia

Abstract

ObjectiveUnipolar mania is a clinical reality in our daily practice. Many authors suggested that bipolar patients can have only manic episodes without depressions. These findings lead us to explore more this particularity.MethodsWe conduct a retrospective, descriptive and comparative study including 173 patients, followed for bipolar disorder type I, according to the Diagnostic and Statistical Manual of Mental Disorders fifth edition criteria, during the period between January 2008 and December 2015. Two groups were identified. The first one was composed of 98 patients who had presented only manic episodes. The second group contained the rest of the sample. Unipolar mania was defined as the presence of three or more manic states without a depressive episode during the period of the study.ResultsOne hundred seventy three patients were included in the study. The average age of the sample was 43 years old. The first episode was manic in 129 patients (74.6%). The dominant polarity was manic in 90.8% of the cases. Seasonal characteristic and psychotic symptoms were observed in respectively 11.0% and 53.2% of the sample. Rapid cycling evolution was observed among 2.3% of patients. The unipolar manic profile accounted for 56.6% of the population. This result is equivalent to an annual incidence of 8%. Comparing the two groups, we did not find a significant difference concerning the sociodemographic and clinical variables except for the number of suicide attempts (p=0.014).ConclusionOur study shows that unipolar mania is clinical evidence. More studies should be conducted in order to understand its nosological and psychopathological foundations.

Differences between unipolar mania and bipolar‐I disorder: Evidence from nine epidemiological studies

“…This difference was even more pronounced in the two adolescent studies (5.6% vs 22.0%). This is in agreement with a long‐term follow‐up study of a sample of hospital admissions in Zurich, with the study of Grobler et al, with the reviews of Yazici and Mehta as well as with the recent finding of Amamou et al in Tunisia . Our observation of a lower proportion of bulimia/binge eating disorders among adults with unipolar mania than among those with BP‐I disorder is a new finding.…”

“…In this connection, Douki et al found unipolar mania to be three times more common among patients in Tunisia than in France. These high rates in Tunisia were recently confirmed by Amamou et al Both Douki et al and Amamou et al attributed these differences to cultural variations and seasonality. Cultural differences in the awareness and experience of depressive and manic symptoms represent a significant limitation of studies on affective disorders.…”

“…From a clinical perspective, there is strong evidence that some patients suffer from pure unipolar mania or mania with mild (not major) depression although it is relatively rare. Notable differences between unipolar mania and BP‐I disorder have been reported in literature reviews and single studies on mania, including a more frequent premorbid hyperthymic temperament, less suicidality, a lower likelihood of developing comorbid anxiety disorders, more psychotic features, and more cannabis abuse for subjects with unipolar mania. In addition, with some exceptions, there is evidence that individuals with pure mania are less likely to have a positive family history for major depressive disorder (MDD) and family studies have found evidence for independent familial aggregation of manic and depressive episodes …”

Comparison of socio-demographic and clinical factors between “unipolar mania” and bipolar affective disorder

“…9 A Indian study published by Avasthi et al reported that 11 out of 50 patients with recurrent manic episodes met the criteria for seasonal affective disorder and had onset in summer or winter rather than autumn or spring. 25 24 However, our study did not find any statistically significant difference though marginally higher in the BPAD group.…”

“…In a study from Tunisia, Amamou et al reported that the rapid cycling phenomena were comparable between the two groups. 24 Psychotic symptoms in the first episode, suicidality, comorbid anxiety, substance use and medical illness, were more common among the BPAD group. In contrast, the seasonality was more common among UM group in our study.…”