Abstract
To the Editor
I have just returned from a psychiatric meeting where the speaker opened with an interesting question. The question was: ‘Do we have a pathognomonic symptom for bipolar disorder?’ We are all familiar with Schneiderian ‘first-rank symptoms’, which are considered pathognomonic of schizophrenia (Schneider, 1959). However this was a question I had not considered before in the context of bipolar disorder. By the end of the evening, I had reflected on my clinical experience of patients with bipolar disorder and came up with the following answer.
I propose ‘extremes in the speed of thought’ as a pathognomonic symptom for bipolar disorder. This is a subjective awareness where the individual experiences a wide range in the speed of their thoughts. In a depressed state, thoughts are perceived as severely slowed. While in the manic state, thoughts are perceived as moving much faster. This is the sole criterion which I advise my patients to apply when they rate their mood charts. Rather than using criteria like mood or activity, I ask that they rate the speed of their thoughts and graph it.
Therefore rather than considering ‘mood swings’ (which lacks specificity) the concept would be closer to ‘thought swings’. I am focusing on extremes of the speed of thought and their variability. In terms of descriptors, we could consider the slower pole of depression as ‘psycho-retardation’ and the faster pole of mania as ‘psycho-acceleration’. One could then classify ‘thought swings’ on the basis of their tempo.
I present this concept for your consideration and to see if these-ideas have been previously expressed.If not, is there face validity for further exploration and discussion?