Everlasting fire - persistent mania: a case report.

Only ash remains after fire is gone. Metaphorically mania is the fire and depression its ash (Koukopoulos & Ghaemi 2009). What is the reason, when there is just fire without ash? Unipolar mania has been described in the literature. Different terms have been used like recurrent mania, chronic mania and persistent mania. But these are scarce diagnoses in psychiatric routine. This topic has got little attention in research of affective disorders, but cases have been reported over the time (Malhi et al. 2001, Solomon et al. 2003, Kraepelin 1921). To fulfill the diagnosis of chronic mania, prominent manic symptoms for more than two years without remission are required (Hare 1981). But no consistent definition of this disorder is available in literature. A contentious issue related to this topic is, if unipolar mania is a separate entity (Harish et al. 2005). Yazici et al. showed, that unipolar mania differs significantly from bipolar disorders e.g. in an earlier onset of illness, a higher presence of psychotic features, a higher rate of hyperthymia, smaller rate of suicide attempts and less response to lithium prophylaxis (Yazici et al. 2002). Further data showed significant differences in a lesser social disability, a lesser anxious worries, and lesser hostility (Perugi et al. 2007). To our knowledge there is no consistent theory explaining the pathomechanism of unipolar mania.