Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study (original) (raw)
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American Journal of Psychiatry, 2004
This study compared demographic and phenomenological variables between bipolar patients with and without rapid cycling as a function of bipolar I versus bipolar II status. Method: The authors examined demographic, historical, and symptomatic features of patients with and without rapid cycling in a cross-sectional study of the first 500 patients with bipolar I or bipolar II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder, a multicenter project funded by the National Institute of Mental Health designed to evaluate the longitudinal outcome of patients with bipolar disorder. Results: Rapid-cycling bipolar disorder occurred in 20% of the study group. Rapidcycling patients were more likely to be women, although the effect was somewhat more pronounced among bipolar I patients than bipolar II patients. In addition , rapid-cycling bipolar patients experienced onset of their illness at a younger age, were more often depressed at study entry, and had poorer global functioning in the year before study entry than nonrapid-cycling patients. Rapid-cycling patients also experienced a significantly greater number of depressive and hypomanic/manic episodes in the prior year. A lifetime history of psychosis did not distinguish between rapid and nonrapidcycling patients, although bipolar I patients were more likely to have experienced psychosis than bipolar II patients. Conclusions: Patients with rapid-cycling bipolar disorder demonstrate a greater severity of illness than nonrapid-cycling patients on a number of clinical measures. This study highlights the need to refine treatments for rapid cycling to reduce the overall morbidity and mortality of patients with this illness course modifier.
Rapid-cycling bipolar I disorder: Course and treatment outcome of a large sample across Europe
Journal of Psychiatric Research, 2008
Objectives: To evaluate the baseline characteristics and follow-up outcomes of rapid-cycling (RC) bipolar I patients in a large, prospective, observational study. Methods: EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) is a long-term prospective observational study of in-and outpatients with an acute mania/mixed episode conducted in 14 European countries. Demographic and clinical variables were collected at baseline, including the presence or absence of DSM-IV rapid-cycling during the past year. Outcome measures included the 5-item Hamilton Depression Rating Scale (HAMD-5) and Young Mania Rating Scale (YMRS) over 12 weeks, as well as the Clinical Global Impressions-Bipolar Disorder Scale (CGI-BP overall, mania and depression) over 12 months. Results: Of 3684 patients enrolled, 3089 patients provided reliable data to qualify for either RC (N = 535, 17.3%) or non-RC (NRC, N = 2554), according to DSM-IV. RC prevalence varied across countries (p < 0.001). Baseline and 12 week outcomes on the YMRS and HAMD-5, 12 month ratings on the CGI-BP subscales and work impairment at 12 months were significantly different (p < 0.001) between groups, being worse in RC. RC patients were more likely to receive antidepressants and lamotrigine (p < 0.001). Using logistic regression, RC was associated to country (p < 0.001), female sex (p = 0.029), outpatients (p = 0.035), more history of attempted suicide (p < 0.001) and alcohol abuse (p < 0.001). Conclusions: The EMBLEM results suggest that in naturalistic settings, patients with mania and RC differ from NRC in socio-demographic characteristics, treatment prescriptions and clinical outcome measures with a consistently worse occupational outcome and comorbidities. RC represents a longitudinally severe form of bipolar disorder, with poorly evidence-based diagnostic and therapeutic tools.
Bipolar Disorders, 2020
Education" (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a major depressive episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as rapid cycling (RC). Methods: Psychiatric symptoms, socio-demographic and clinical variables were collected from a sample of 2811 MDE patients, out of which 726 (25.8 %) were diagnosed with bipolar disorder (BD). The characteristics of bipolar patients with RC (BD-RC) and without (BD-NRC) RC were compared. Results: Out of 726 BD patients, 159 (21.9 %) met DSM-5 criteria for RC. BD-RC group presented a higher number of lifetime depressive episodes (p < 0.001) with shorter duration of depressive episodes, and more psychiatric comorbidities, as well Accepted Article This article is protected by copyright. All rights reserved as higher rates of atypical features (p = 0.016) and concomitant (hypo)manic symptoms (irritable mood (p = 0.001); risky behavior (p = 0.005); impulsivity (p = 0.006); psychomotor agitation (p = 0.029)). Patients with RC had a worse functioning (p = 0.033), more obesity (p = 0.003) and were significantly more likely to be treated with three or more drugs (p = 0.007). Conclusions: Important clinical differences between bipolar patients with and without a RC include more depressive morbidity, higher incidence of anxiety disorders, addiction, bulimia and borderline personality disorder, as well as atypical features during depression and symptoms such as irritability, risky behavior, impulsivity and agitation. RC patients had poorer functioning than patients without RC, more obesity, and had to be treated with more drugs.
Suicide risk in rapid cycling bipolar patients
Journal of Affective Disorders, 2009
Background: Rapid-cycling (RC) is a course modifier of bipolar disorder which often implicates a poor prognosis. However, the relationship of RC with suicidal features as a marker of impairment has been understudied. Methods: Three hundred and five patients (n = 305) were included in a naturalistic, systematic prospective study in a single site setting. Patients with rapid-cycling (RC) were defined as having four or more manic, mixed or depressive episodes in the year prior to baseline assessment. The two groups were compared regarding clinical and sociodemographic variables, paying special attention to suicidal features. Statistical methods consisted of chi-square statistic for the comparison of categorical data, and Student's t test for dimensional variables normally distributed. Also, a General Linear Model was used to study the main effect of different sociodemographic and clinical variables on suicidality. All statistics were two-tailed, and significance was set at p less than 0.05. Results: Fifty-five patients (18%) were classified as RC, whilst 250 (82%) were considered as nonrapid-cycling (NRC). No significative difference was found in the prevalence of RC amongst bipolar I and II patients. RC was associated with depressive onset of bipolar disorder. The number of suicide attempts was significantly higher amongst RC (RC mean 0.82 [SD 1.85] vs. NRC 0.44[SD 0.94] t = 2.09, p = 0.37). Nonetheless, no significative differences were found between RC and NRC regarding the percentage of suicide attempters. On the other hand patients that presented RC showed a marked increase of lifetime history of suicidal ideation (Chi 2 = 4.363, p = 0.039). Finally, there were not any differences between RC patients and NRC in family history of suicide. Discussion: Bipolar patients with RC are more likely to attempt suicide. Intensive treatment of this marker should be considered.
Rapid cycling in women and men with bipolar manic-depressive disorders
The American journal of psychiatry, 1998
This study investigated risks for rapid cycling, as defined by DSM-IV, in women and men with bipolar disorders. The results of 10 studies with a total of 2,057 bipolar patients were meta-analyzed by pooled contingency methods. The proportions of women and men among rapid-cycling cases averaged 72% and 28%, respectively, but the risk of rapid cycling was inconsistently more frequent among women (29.6%) than among men (16.5%). The mean number of episodes per year was much higher in rapid-cycling patients before and during lithium treatment but was similar in rapid-cycling men and women. Rapid cycling was only moderately, and inconsistently, more common in bipolar women than men.
Psychiatria Danubina, 2014
Background: Rapid cycling in bipolar disorder complicates the clinical picture and worsens the long-term outcomes of bipolar disorder. Mixed states features do similarly and are known to present an increased risk to patients. Early recognition of these patterns can lead to better treatment strategies and improvement of the long-term course of the disease. Method: We collected data from the clinical notes of 70 bipolar outpatients seen at an ASPA (initial assessment) clinic about socio-demographic and clinical characteristics. Results: The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; percentages reported in our results are of the sample for which the data was available. 71.7 % (33 patients) of the sample reported mixed states features and 32 patients (72.7%) are recorded to have more than 4 changes in mood in a year. There were no statistically significant correlations between mixed state features or rapid cycling and anhedonia, suicidal ideation, borderline symptoms, OCD symptoms, anxiety, positive psychiatric family history, current alcohol use, previous alcohol use, current illicit drug use, or previous illicit drug use. An almost significant correlation was found between mixed state features and anxiety. Assignation of a care coordinator did not seem to be associated with these prognostic factors. Conclusions: The two subgroups of mixed state features and rapid cycling patients share very common clinical characteristics: high incidence of suicidal thoughts, high levels of anxiety, and high previous substance use-but low levels of current alcohol and drug use and high levels of features of atypical depression. These features of mixed state bipolar disorder and rapid cycling bipolar disorder should be identified during psychiatric assessment to identify useful information for prognosis.
European Psychiatry
Background: we aimed to compare socio-demographic and clinical differences between patients with versus without current RC in order to detect clinical factors that may favor early diagnosis and personalized treatment. Methods: A total of 1675 patients (males: n = 714 and females: n = 961; bipolar 1: n = 1042 and bipolar 2: n = 633) from different psychiatric clinics were grouped and compared according to the current presence of RC in terms of socio-demographic and clinical variables. Chi-squared tests for qualitative variables and Student’s t tests for quantitative variables were executed for group comparison, and multivariable logistic regressions were performed, considering the current presence of RC as dependent variable, and socio-demographic/clinical factors as independent variables. Results: Female gender (male versus female: OR = 0.64, p = 0.04), unidentifiable prevalent polarity (versus depressive polarity: OR = 1.76, p = 0.02; versus manic polarity: OR: 2.86, p < 0.01) a...