Manic-depressive psychosis was long known as a cyclic or circular illness, but actually only 15 to 25 per cent of patients have been found to alternate between manic and depressive phases. When alternation does take place, the change-over is usually direct, although sometimes there is an interval in which the patient is free of symptoms for weeks, months, or even years.The different phases of the disorder may vary considerably in intensity and duration—for example, a long period of severe depression may be followed immediately by a short hypomanic reaction, or acute mania may be followed by a mild depression. The sequence may also be irregular, some patients experiencing more than one depressive or manic phase before the opposite state takes over.n mixed reactions, manic and depressive reactions occur in combination. There are many varieties, and some authorities question the value of classifying them as separate disorders, since they are all manifestations of the same disease process. These combinations include agitated depression, unproductive mania, inhibited mania, depressive mania, depression with flight, and manic stupor. In manic stupor the patient is elated but practically inactive and unproductive of ideas. In agitated depression, which is the most common combination, the patient feels extremely depressed, anxious, and threatened, and reacts to his uneasiness with restlessness and excitement. He assails himself with self-accusations while pacing the floor, wringing his hands, and bewailing his fate. See agitation.Illustrative Case: manic-depressive reaction (CIRCULAR TYPE)J.M., female, forty-four, married, housewife. Diagnosis: Manic-depressive psychosis, circular type. Family history negative.Personal History: Was healthy, active child, described as bright and quick-tempered. Outgoing, fond of social affairs, much interested in sports, put a great deal of zest into everything she did. Married at twenty; for several years was happy and well adjusted. At twenty-eight gave birth to a child after going through serious and prolonged labor. One year later developed thyroid difficulty; although operation was successful, was depressed for several months. Several years later husband suffered financial reverses and patient was greatly upset for two months. Husband’s business recovered and became better than ever, and patient seemed again happy and satisfied. Two years later became excessively “blue” at monthly period, cried and said she wished she were dead. Following this became excited, over- active, and expansive. Spent money recklessly, gave parties, and indulged in several flirtations.Finally brought to hospital and since that time has gone through two depressions and two periods of excitement. During depressed periods she is sad, dejected, engages in no activity, and speaks almost entirely in monosyllables. Frequently takes a minute or two to answer a simple question and then replies in a dismal tone with a single word. Gives the appearance of one who has the weight of the world on her shoulders. Usually sits with head bowed, brow wrinkled, hands clasped in lap. Even simplest request appears to require too much activity; when she does speak, it is only to say that she is very sick.In manic phase we would not recognize her as the same individual. Impossible for her to remain still for an instant. She is all over the ward, dancing, singing, slapping patients and nurses on the back, pulling offher clothes, and throwing things about with absolute abandon. She writes poetry and insists on reciting it to everyone near her, monopolizes the conversation, and has a flippant reply for every remark that is made by anyone else. In these phases she becomes unusually demanding; when repulsed is abusive both in language and activity. A good bit of her behavior at this time is erotic. She tears off her clothing, talks of her sex appeal and of men trying to seduce her, and throws her arms about any man who happens to appear. (Dorcus and Shaffer, 1945) Illustrative Case: manic-depressive reaction (mixed type, manic stupor)F.D., twenty-three, male, single. Admitted to hospital with diagnosis of manic- depressive psychosis, manic stupor. Behavior first noted by family to be unusual about fifteen months ago. Was exceedingly hilarious, overactive, and silly. Continued in this fashion about two months, after which he became less active and talkative but still acted childish in many respects. During past four months has become practically immobile (confines himself to his home, and more often to his room), rarely says anything, and appears to be in a fog. Expression is one of elation. (Thorpe, Katz, and Lewis, 1961)Illustrative Case: manic-depressive reaction (MIXED TYPE, AGITATED DEPRESSION) Expression is one of apprehension and sadness. Is restless and agitated. Unable to sit still or go to bed. Wrings hands, runs hands through hair, paces floor. Utters phrases of despair: “Oh my God, Oh my God.” and “Let me die, let me die.” In three weeks lost twenty-three pounds (from 164 to 141). Although he appears to be oriented (realizes he is in a mental hospital), he fails to recognize his children. Whenever he sees his wife he cries, “Don’t come near me, I am saturated with disease.” He evidenced no hallucinations. (Thorpe, Katz, and Lewis, 1961)

Cite this page: N., Pam M.S., "MANIC-DEPRESSIVE REACTION (CIRCULAR AND MIXED TYPES)," in, November 28, 2018, (accessed June 20, 2019).