Recurrent Unipolar Mania: Does it Warrant a Separate Nosological Status?

The concept of unipolar mania, unlike unipolar depression, has received relatively little attention. We review the research available on the validity of it as a separate entity. Studies show that there are few consistent differences in sociodemographic and family history variables in unipolar mania compared to other bipolar disorders, but there are a few differences regarding clinical picture, neuroimaging and response to lithium. Many studies have come from nonwestern countries or settings, probably indicating an influence of culture on the disorder. The debate on the nosological status of unipolar recurrent mania seems premature in view of the lack of consensus on the very definition of the condition and the difficulties inherent in constructing such a definition. There appears, however, sufficient evidence to indicate that the issue merits further study, because there are a sizeable number of patients, reported from several countries and cultures, who demonstrate a recurrent unipolar manic course. As a way out of this dilemma, we propose that a course specifier be added to the diagnosis of bipolar disorder indicating the course of unipolar recurrent mania. This will currently obviate the need to debate whether unipolar recurrent mania is a distinct ‘disorder’; rather, the focus will be on the course of the broad rubric of bipolar disorder. This will also generate systematic data, which then can be subjected to a more formal analysis. Tentative operational criteria for the course specifier categories are proposed (German J Psychiatry 2005;8(1):8-15).