La psychiatrie et les troubles bipolaires

La psychiatrie et les troubles bipolaires

Variantes de la psychose maniaco-dépressive

Le psychiatre allemand, E. Kraepelin, rédige son Traité de psychiatrie (1883-1915) dans lequel il expose une classification des maladies mentales. Son observation et sa pratique clinique, auprès de patients psychotiques, lui permet de distinguer deux entités morbides : les psychoses maniaco-dépressives et les démences précoces ou schizophrénies.


En 1899 E. Kraepelin apporte des précisions nosographiques et parle de psychose maniaco-dépressive (PMD), il considère que la manie et la dépression ne sont en réalité que des variantes de la psychose maniaco-dépressive. En 1953 K. Kleist préfère employer les termes d’« unipolaires » et « bipolaires » en ce qui concerne les troubles de l’humeur. Dans les années 1960, la psychose maniaco-dépressive sera progressivement remplacée par une terminologie plus diversifiée, il sera question de dépression unipolaire, de spectre bipolaire ou de troubles bipolaires (TBP).

Différences entre psychose maniaco-dépressive et troubles bipolaires

Pourquoi avoir différencié la psychose maniaco-dépressive des troubles bipolaires ? La différence réside dans le simple constat qu’un certain nombre de patients présentait des troubles de l’humeur avec une oscillation entre des phases dépressives et des épisodes maniaques, sans pour autant présenter des délires ou des hallucinations. Pour les patients présentant un trouble bipolaire, le lien à la réalité est préservé, tandis que dans le champ clinique de la psychose, l’identité de l’individu est morcelée et le rapport du sujet à la réalité est fortement perturbé.

Certains auteurs considèrent que les troubles bipolaires sont à rapprocher des troubles narcissiques ou états limites. La psychose maniaco-dépressive représente alors une entité clinique se rapportant à la psychose, le patient présentant alors une alternance brusque entre des phases dépressives et des épisodes maniaques, accompagnée d’une rupture avec la réalité.

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