Characteristics of rapid cycling in 1261 bipolar disorder patients
Abstract Background Rapid-cycling (RC; ≥ 4 episodes/year) in bipolar disorder (BD) has been recognized since the 1970s and associated with inferior treatment response. However, associations of single years of RC with overall cycling rate, long-term morbidity, and diagnostic subtypes are not clear. R...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-06-01
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| Series: | International Journal of Bipolar Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40345-023-00300-z |
| _version_ | 1797806944963002368 |
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| author | Alessandro Miola Leonardo Tondo Marco Pinna Martina Contu Ross J. Baldessarini |
| author_facet | Alessandro Miola Leonardo Tondo Marco Pinna Martina Contu Ross J. Baldessarini |
| author_sort | Alessandro Miola |
| collection | DOAJ |
| description | Abstract Background Rapid-cycling (RC; ≥ 4 episodes/year) in bipolar disorder (BD) has been recognized since the 1970s and associated with inferior treatment response. However, associations of single years of RC with overall cycling rate, long-term morbidity, and diagnostic subtypes are not clear. Results We compared descriptive and clinical characteristics in 1261 BD patients with/without RC, based on history and prospective follow-up for several years. RC in any previous year was identified in 9.36% of BD subjects (3.74% in BD1, 15.2% BD2), and somewhat more among women than men. RC-BD subjects had 3.21-fold greater average prospective annual rates of recurrence but not hospitalizations, had less difference in %-time-ill, received more mood-stabilizing treatments, and had greater suicidal risk, lacked familial psychiatric illnesses, had more cyclothymic temperament, were more likely to be married, had more siblings and children, experienced early sexual abuse, but were less likely to abuse drugs (not alcohol) or smoke. In multivariable regression modeling, older age, mood-switching with antidepressants, and BD2 > BD1 diagnosis, as well as more episodes/year were independently associated with RC. Notably, prospective mean recurrence rates were below 4/year in 79.5% of previously RC patients, and below 2/year in 48.1%. Conclusions Lifetime risk of RC in BD was 9.36%, more likely in women, with older age, and in BD2 > BD1. With RC, recurrence rates were much higher, especially for depression with less effect on %-time ill, suggesting shorter episodes. Variable associations with unfavorable outcomes and prospective recurrence rates well below 4/year in most previously RC patients indicate that RC was not a sustained characteristic and probably was associated with use of antidepressants. |
| first_indexed | 2024-03-13T06:15:05Z |
| format | Article |
| id | doaj.art-e961fc603a934923bd0c6df92c85126a |
| institution | Directory Open Access Journal |
| issn | 2194-7511 |
| language | English |
| last_indexed | 2024-03-13T06:15:05Z |
| publishDate | 2023-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | International Journal of Bipolar Disorders |
| spelling | doaj.art-e961fc603a934923bd0c6df92c85126a2023-06-11T11:03:59ZengSpringerOpenInternational Journal of Bipolar Disorders2194-75112023-06-0111111010.1186/s40345-023-00300-zCharacteristics of rapid cycling in 1261 bipolar disorder patientsAlessandro Miola0Leonardo Tondo1Marco Pinna2Martina Contu3Ross J. Baldessarini4Department of Psychiatry, University of PadovaInternational Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean HospitalLucio Bini Mood Disorder CentersLucio Bini Mood Disorder CentersInternational Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean HospitalAbstract Background Rapid-cycling (RC; ≥ 4 episodes/year) in bipolar disorder (BD) has been recognized since the 1970s and associated with inferior treatment response. However, associations of single years of RC with overall cycling rate, long-term morbidity, and diagnostic subtypes are not clear. Results We compared descriptive and clinical characteristics in 1261 BD patients with/without RC, based on history and prospective follow-up for several years. RC in any previous year was identified in 9.36% of BD subjects (3.74% in BD1, 15.2% BD2), and somewhat more among women than men. RC-BD subjects had 3.21-fold greater average prospective annual rates of recurrence but not hospitalizations, had less difference in %-time-ill, received more mood-stabilizing treatments, and had greater suicidal risk, lacked familial psychiatric illnesses, had more cyclothymic temperament, were more likely to be married, had more siblings and children, experienced early sexual abuse, but were less likely to abuse drugs (not alcohol) or smoke. In multivariable regression modeling, older age, mood-switching with antidepressants, and BD2 > BD1 diagnosis, as well as more episodes/year were independently associated with RC. Notably, prospective mean recurrence rates were below 4/year in 79.5% of previously RC patients, and below 2/year in 48.1%. Conclusions Lifetime risk of RC in BD was 9.36%, more likely in women, with older age, and in BD2 > BD1. With RC, recurrence rates were much higher, especially for depression with less effect on %-time ill, suggesting shorter episodes. Variable associations with unfavorable outcomes and prospective recurrence rates well below 4/year in most previously RC patients indicate that RC was not a sustained characteristic and probably was associated with use of antidepressants.https://doi.org/10.1186/s40345-023-00300-zBipolar disorderEpisode frequencyMorbidityRapid-cycling courseRisk factorsTemperament |
| spellingShingle | Alessandro Miola Leonardo Tondo Marco Pinna Martina Contu Ross J. Baldessarini Characteristics of rapid cycling in 1261 bipolar disorder patients International Journal of Bipolar Disorders Bipolar disorder Episode frequency Morbidity Rapid-cycling course Risk factors Temperament |
| title | Characteristics of rapid cycling in 1261 bipolar disorder patients |
| title_full | Characteristics of rapid cycling in 1261 bipolar disorder patients |
| title_fullStr | Characteristics of rapid cycling in 1261 bipolar disorder patients |
| title_full_unstemmed | Characteristics of rapid cycling in 1261 bipolar disorder patients |
| title_short | Characteristics of rapid cycling in 1261 bipolar disorder patients |
| title_sort | characteristics of rapid cycling in 1261 bipolar disorder patients |
| topic | Bipolar disorder Episode frequency Morbidity Rapid-cycling course Risk factors Temperament |
| url | https://doi.org/10.1186/s40345-023-00300-z |
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