Phenomenology of rapid-cycling bipolar disorder: data from the first 500 participants in the Systematic Treatment Enhancement Program.

Journal article

OBJECTIVE: 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. Rapid-cycling 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 nonrapid-cycling 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.

Authors: Schneck, C; Miklowitz, D; Calabrese, JR; Allen, M; Thomas, MR

• Publication status: Published
• Journal: American journal of psychiatry
• Volume: 161
• Issue: 10
• Pages: 1902-1908
• Publication date: 2004-10-01
• DOI: 10.1176/ajp.161.10.1902
• EISSN: 1535-7228
• ISSN: 0002-953X
• Language: English
• Keywords: Cohort Studies; Adult; Depressive Disorder; Comorbidity; Substance-Related Disorders; Diagnosis, Dual (Psychiatry); Psychiatric Status Rating Scales; Diagnosis, Differential; Bipolar Disorder; Female; Male; Prevalence; Severity of Illness Index; Humans; Sex Factors; Age of Onset; Cross-Sectional Studies