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: 12.3). 04/2008; 165(3):370-7; quiz 410. DOI: 10.1176/appi.ajp.2007.05081484
Source: PubMed


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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    • "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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    ABSTRACT: BACKGROUND: Gender differences in treatment that are not supported by empirical evidence have been reported in several areas of medicine. Here, the aim was to evaluate potential gender differences in the treatment for bipolar disorder. METHODS: Data was collected from the Swedish National Quality Assurance Register for bipolar disorder (BipoläR). Baseline registrations from the period 2004-2011 of 7354 patients were analyzed. Multiple logistic regression analysis was used to study the impact of gender on interventions. RESULTS: Women were more often treated with antidepressants, lamotrigine, electroconvulsive therapy, benzodiazepines, and psychotherapy. Men were more often treated with lithium. There were no gender differences in treatment with mood stabilizers as a group, neuroleptics, or valproate. Subgroup analyses revealed that ECT was more common in women only in the bipolar I subgroup. Contrariwise, lamotrigine was more common in women only in the bipolar II subgroup. LIMITATIONS: As BipoläR contains data on outpatient treatment of persons with bipolar disorder in Sweden, it is unclear if these findings translate to inpatient care and to outpatient treatment in other countries. CONCLUSIONS: Men and women with bipolar disorder receive different treatments in routine clinical settings in Sweden. Gender differences in level of functioning, bipolar subtype, or severity of bipolar disorder could not explain the higher prevalence of pharmacological treatment, electroconvulsive therapy, and psychotherapy in women. Our results suggest that clinicians׳ treatment decisions are to some extent unduly influenced by patients׳ gender.
    Journal of Affective Disorders 12/2014; 174C:303-309. DOI:10.1016/j.jad.2014.11.058 · 3.38 Impact Factor
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    • "In a study which included patients with rapid cycling (RC) bipolar II disorder, those with non-RC BD, and healthy controls, the Glx level in the left dorsolateral PFC turned out to be significantly higher in the RC group in all mood states [42]. Although the study was conducted in a small population at a preliminary scale, the fact that the RC subtype is considered as a severe BD subtype [43] implicates the possibility that the elevated Glx level may be an important factor in the manifestation of characteristic symptoms of BD. "
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    ABSTRACT: The role of glutamatergic system in the neurobiology of mood disorders draws increasing attention, as disturbance of this system is consistently implicated in mood disorders including major depressive disorder and bipolar disorder. Thus, the glutamate hypothesis of mood disorders is expected to complement and improve the prevailing monoamine hypothesis, and may indicate novel therapeutic targets. Since the contribution of astrocytes is found to be crucial not only in the modulation of the glutamatergic system but also in the maintenance of brain energy metabolism, alterations in the astrocytic function and neuroenergetic environment are suggested as the potential neurobiological underpinnings of mood disorders. In the present review, the evidence of glutamatergic abnormalities in mood disorders based on postmortem and magnetic resonance spectroscopy (MRS) studies is presented, and disrupted energy metabolism involving astrocytic dysfunction is proposed as the underlying mechanism linking altered energy metabolism, perturbations in the glutamatergic system, and pathogenesis of mood disorders.
    03/2014; 23(1):28-35. DOI:10.5607/en.2014.23.1.28
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