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Here is an editorial from the current chairman of the International Society for Bipolar Disorders, Gin Malhi. It is co-written with his fellow Sydney psychiatrist, Erica Bell. They call for a complete transformation in the conception of bipolar disorders, asserting that mixed states belie the concept of a bipolar view of mood disorders. Instead, they want to substitute what they call the ACE model—affect, cognition, and energy. In their model, which they attribute originally to Emil Kraepelin, these 3 variables—affect, cognition, and energy—can vary from very low to very high, just like mood does in a 2-pole conception of bipolar disorder. However, here, the 3 variables are allowed to vary independently. When all 3 go down together, it is a pure depressive episode. Mood is depressed, cognitions are negative and often slowed, and energy is low, often profoundly low. When all 3 rise together—affect, cognition, and energy—it is a manic
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