The Prospective Course of Rapid-Cycling Bipolar Disorder: Findings From the STEP-BD

Department of Psychiatry, University of Colorado, Denver, Colorado, United States
American Journal of Psychiatry (Impact Factor: 13.56). 04/2008; 165(3):370-7; quiz 410. DOI: 10.1176/appi.ajp.2007.05081484
Source: PubMed

ABSTRACT In a naturalistic follow-up of adult bipolar patients, the authors examined the contributions of demographic, phenomenological, and clinical variables, including antidepressant use, to prospectively observed mood episode frequency.
For 1,742 bipolar I and II patients in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), episodes of mood disorders were evaluated for up to 1 year of treatment.
At entry, 32% of the patients met the DSM-IV criteria for rapid cycling in the prestudy year. Of the 1,742 patients, 551 (32%) did not complete 1 year of treatment. Among the 1,191 patients remaining, those with prior rapid cycling (N=356) were more likely to have further recurrences, although not necessarily more than four episodes per year. At the end of 12 months, only 5% (N=58) of the patients could be classified as rapid cyclers; 34% (N=409) had no further mood episodes, 34% (N=402) experienced one episode, and 27% (N=322) had two or three episodes. Patients who entered the study with earlier illness onset and greater severity were more likely to have one or more episodes in the prospective study year. Antidepressant use during follow-up was associated with more frequent mood episodes.
While DSM-IV rapid cycling was prospectively observed in only a small percentage of patients, the majority of these patients had continued recurrences at lower but clinically significant rates. This suggests that cycling is on a continuum and that prevention of recurrences may require early intervention and restricted use of antidepressants.

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Available from: Laszlo Gyulai, Aug 17, 2015
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    • "Previous studies on dropout cases with mental disorders have reported dropout rates ranging between 15 and 46% and dropouts mostly occur in early treatment, particularly after the first or second visit (Olfson et al., 2009; Percudani et al., 2002; Wells et al., 2013). A few number of studies have highlighted the clinical importance of dropout in bipolar disorders, reporting dropout rates of 32–38% (Dittmann et al., 2003; Mazza et al., 2009; Moon et al., 2012; Schneck et al., 2008). In the current study the dropout rate was 21.3%, which was lower than rates in previous studies conducted on bipolar disorders. "
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    ABSTRACT: Dropout is a common problem in the treatment of psychiatric illnesses including bipolar disorders (BD). The aim of the present study is to investigate illness perceptions of dropout patients with BD. A cross sectional study was done on the participants who attended the Mood Disorder Outpatient Clinic at least 3 times from January 2003 through June 2008, and then failed to attend clinic till to the last one year, 2009, determined as dropout. Thirty-nine dropout patients and 39 attendent patients with BD were recruited for this study. A sociodemographic form and brief illness perception questionnaire were used to capture data. The main reasons of patients with BD for dropout were difficulties of transport (31%), to visit another doctor (26%), giving up drugs (13%) and low education level (59%) is significant for dropout patients. The dropout patients reported that their illness did not critically influence their lives, their treatment had failed to control their illnesses, they had no symptoms, and that their illness did not emotionally affect them. In conclusion, the nonattendance of patients with serious mental illness can result in non-compliance of therapeutic drug regimens, and a recurrence of the appearance symptoms. The perception of illness in dropout patients with BD may be important for understanding and preventing nonattendance. Copyright © 2015 Elsevier B.V. All rights reserved.
    Asian Journal of Psychiatry 04/2015; 15. DOI:10.1016/j.ajp.2015.04.006
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    • "Many, but not all, studies report that women with bipolar disorder are more likely to suffer from subsyndromal depressed mood and dysphoria (Altshuler et al., 2010; Diflorio and Jones, 2010; Morgan et al., 2005; Rasgon et al., 2005a), even though the number of depressives episodes and the time spent in syndromal depression do not differ between men and women (Baldassano et al., 2005; Diflorio and Jones, 2010; Grant et al., 2005; Hendrick et al., 2000; Kawa et al., 2005; Kessing, 2004; Suominen et al., 2009). A majority of studies shows that women are more likely than men to be diagnosed with the BP II subtype, and to experience hypomanic episodes (Angst, 1998; Baldassano et al., 2005; Cassano et al., 1992; Diflorio and Jones, 2010; Merikangas et al., 2011; Schneck et al., 2008). Finally, a number of studies point out that women are more likely than men to suffer from mixed episodes (Benazzi, 2003; Diflorio and Jones, 2010; Grant et al., 2005; Kessing, 2004, 2008; Suppes et al., 2005). "
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    Journal of Affective Disorders 12/2014; 174C:303-309. DOI:10.1016/j.jad.2014.11.058 · 3.71 Impact Factor
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    • "Ainsi, il est nécessaire de réduire au maximum les symptômes résiduels ce qui constituera par la suite un élément essentiel du pronostic du patient traité. Par ailleurs, des antécédents de cycles rapides constituent également un risque plus important de rechutes [18]. "
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    ABSTRACT: Bipolar disorder (BD) is the seventh leading cause of disability per year of life among all diseases in the population aged 15 to 44. It is a group of heterogeneous diseases, with frequent comorbid psychiatric or somatic disorders, variable treatment response and frequent residual symptoms between episodes. The major impairment associated with this disorder is related to the high relapse and recurrence rates, the functional impact of comorbidities and cognitive impairment between episodes. The prognosis of the disease relies on the efficacy of relapse and recurrence prevention interventions. Given the heterogeneity of the disorder, relapse and recurrence prevention needs to develop a personalized care plan from the start of the acute phase. In such a complex situation, guideline-driven algorithms of decision are known to improve overall care of patients with bipolar disorder, compared to standard treatment decisions. Although guidelines do not account for all the situations encountered with patients, this systematic approach contributes to the development of personalized medicine. We present a critical review of recent international recommendations for the management of manic phases. We summarize treatment options that reach consensus (monotherapy and combination therapy) and comment on options that differ across guidelines. The synthesis of recent international guidelines shows a consensus for the initial treatment for manic phases. For acute and long-term management, the anti-manic drugs proposed are traditional mood stabilizers (lithium or valproate) and atypical antipsychotics (APA - olanzapine, risperidone, aripiprazole and quetiapine). All guidelines indicate stopping antidepressant drugs during manic phases. International guidelines also present with some differences. First, as monotherapy is often non sufficient in clinical practice, combination therapy with a traditional mood stabilizer and an APA are disputed either in first line treatment for severe cases or in second line. Second, mixed episodes treatment is not consensual either and some guidelines propose in first line valproate, carbamazepine and some APA, and advice not to use lithium. On the other hand, some guidelines do not propose specific treatment for mixed episodes and group them with manic episodes management. Duration of treatment is unclear. Guidelines utilization has shown that the systemic use by clinicians of decision algorithms in comparison to "treatment as usual" modality improves the overall care of patients with BD. Future data from cohorts of patients seem necessary to complement the existing data from clinical trials. These cohort studies will help to take into account the different individual profiles of BD and thus may help to propose a more personalized medicine.
    L Encéphale 02/2014; · 0.60 Impact Factor
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