Rapid and non-rapid bipolar disorder: A meta-analysis of clinical studies

Altrecht Institute for Mental Health Care and University Medical Center Utrecht, Utrecht, The Netherlands.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 12/2003; 64(12):1483-94. DOI: 10.4088/JCP.v64n1213
Source: PubMed


Rapid cycling, defined as 4 or more mood episodes per year, is a course specifier of bipolar disorder associated with relative treatment resistance. Several risk factors have been suggested to be associated with rapid cycling. The purpose of this meta-analysis was to compare clinical studies for the evidence of discriminating factors between rapid and non-rapid cycling.
We searched MEDLINE and reference lists of articles and book chapters and selected all of the clinical studies published from 1974 to 2002 comparing subjects with rapid and non-rapid cycling bipolar disorder. Prevalence rates and mean random effect sizes for 18 potential risk factors that were reported by at least 3 studies were calculated. In addition, we differentiated between current and lifetime diagnoses of rapid cycling.
Twenty studies were identified. Rapid cycling was present in 16.3% of 2054 bipolar patients in 8 studies that included patients who were consecutively admitted to an inpatient or outpatient facility, without a priori selection of rapid cyclers and without matching the numbers of rapid cyclers to non-rapid cycling controls. Female gender and bipolar II subtype both had a small, but statistically significant, effect (p <.000 for female gender, p <.001 for bipolar II subtype). The further absence of recurrences with lithium prophylaxis was reported in 34% of rapid cyclers compared with 47% of non-rapid cyclers, a nearly significant difference, and a partial response was present in 59% and 65% of patients, respectively. The effect of hypothyroidism was significant (p <.01) in studies using current, but not lifetime, definitions of rapid cycling. In 46% of cases, a rapid cycling course was preceded by treatment with antidepressants, but systematic data on their causal role are lacking.
Rapid cycling is slightly more prevalent in women and in patients with bipolar II subtype. In contrast to common opinion, lithium prophylaxis has at least partial efficacy in a considerable number of rapid cyclers, especially when antidepressants are avoided. Hypothyroidism may be associated with mood destabilization in vulnerable patients.

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    • "Specifically, although BD-I may be a more severe form of the disorder (e.g., presence of psychosis, more acute impairment), BD-II is generally more chronic, with higher rates of depression, episode switching, and anxiety comorbidity (Vieta et al., 1997; Judd et al., 2003a; 2003b). The presence of rapid cycling is also linked with greater illness severity, suicide risk, and treatment failure (Coryell et al., 2003; Kupka et al., 2003; Contents lists available at ScienceDirect journal homepage: Tondo et al., 2003). "
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    ABSTRACT: Bipolar disorder (BD) is highly heterogeneous, and course variations are associated with patient outcomes. This diagnostic complexity challenges identification of patients in greatest need of intervention. Additionally, course variations have implications for offspring risk. First, latent class analysis (LCA) categorized parents with BD based on salient illness characteristics: BD type, onset age, polarity of index episode, pole of majority of episodes, rapid cycling, psychosis, anxiety comorbidity, and substance dependence. Fit indices favored three parental classes with some substantively meaningful patterns. Two classes, labeled "Earlier-Onset Bipolar-I" (EO-I) and "Earlier-Onset Bipolar-II" (EO-II), comprised parents who had a mean onset age in mid-adolescence, with EO-I primarily BD-I parents and EO-II entirely BD-II parents. The third class, labeled "Later-Onset BD" (LO) had an average onset age in adulthood. Classes also varied on probability of anxiety comorbidity, substance dependence, psychosis, rapid cycling, and pole of majority of episodes. Second, we examined rates of disorders in offspring (ages 4-33, Mage=13.46) based on parental latent class membership. Differences emerged for offspring anxiety disorders only such that offspring of EO-I and EO-II parents had higher rates, compared to offspring of LO parents, particularly for daughters. Findings may enhance understanding of BD and its nosology.
    09/2015; DOI:10.1016/j.psychres.2015.09.011
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    • "Rapid cycling affects approximately 20% of all adult patients with bipolar disorder (BD) (Kupka et al., 2003; Schneck et al., 2004). In addition, rapid cycling bipolar disorder (RC-BD) is associated with medical and psychiatric comorbid disorders that have been shown to lead to increased risk for mixed states, high symptom severity, aggression and suicidality (Frye et al., 2006; Kemp et al., 2010). "
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    ABSTRACT: Background Obesity seems to show a two-way relationship with bipolar disorder (BD), representing not only a possible vulnerability factor but also a consequence of chronic mood dysregulation associated with an overall poor prognosis. Increased impulsivity has been described across all stages and phases of BD as being also associated with a worse prognosis. Although obesity and impulsivity are common features among rapid cycling bipolar disorder (RC-BD) patients, there is a lack of understanding about the clinical implications of these conditions combined in BD. Methods To explore and integrate available evidence on shared clinical associations between obesity and impulsivity in RC-BD a systematic search of the literature in the electronic database of the National Library of Medicine (PubMed) has been conducted. Results One hundred and fourteen articles were included in our systematic review. Among RC-BD patients, substance abuse disorders (SUDs), anxiety disorders (ADs), predominantly depressive polarity, chronic exposure to antidepressants, psychotic symptoms, suicidality, and comorbid medical conditions are strongly associated with both obesity and impulsivity. Limitations Heterogeneity of published data, inconsistent measurements of both obesity and impulsivity in RC-BD and an absence of control for RC-BD in epidemiological surveys. Consequently, their combined impact on the severity of RC-BD is yet to be recognized and remains to be poorly understood. Conclusion In RC-BD patients the co-occurrence of obesity and impulsivity is associated with an unfavorable course of illness, specific shared clinical correlates, negative psychosocial impact, and overall worse prognosis. There is a need to examine obesity and impulsivity as modulating factors and markers of severity in RC-BD.
    Journal of Affective Disorders 06/2014; 168. DOI:10.1016/j.jad.2014.05.054 · 3.38 Impact Factor
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    • "Due to the quality and quantity of evidence, this guideline has its primary focus on bipolar I disorder . However, despite belonging to the same spectrum , the longitudinal course of bipolar I and II disorder is distinct enough to allow separation as separate subcategories (Judd et al. 2003; Vieta and Suppes 2008) and while it is becoming apparent that to defi ne rapid cycling in a separate category is to some degree artifi cial (Kupka et al. 2003, 2005) it is still consistently applied in prophylactic treatment trials. Therefore, when evidence is available, we will also refer to bipolar II disorder and rapid cycling patients. "

    The World Journal of Biological Psychiatry 04/2013; 14(3):154-219. DOI:10.3109/15622975.2013.770551. · 4.18 Impact Factor
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