Fifty manic probands were examined for age at first onset of affective illness, subsequent clinical course, any associated alcoholism, drug abuse, sociopathy or homosexuality. Information was obtained for all first-degree relatives for history and type of affective illness.
Onset of affective illness before age 30 was associated with a bipolar illness course, equal number of prior attacks of mania and depression, and a high prevalence of affective disorder, alcoholism, drug abuse, and sociopathy in first-degree relatives. Onset of affective illness after age 30 was associated with a unipolar manic course, excess prior attacks of mania, and a dearth of affective illness and associated conditions in first-degree relatives.
These data suggest that mania is not a single clinical entity and should not be used as the sole criterion for the diagnosis of bipolar illness.