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RAPID-CYCLING BIPOLAR DISORDER

1999; Elsevier BV; Volume: 22; Issue: 3 Linguagem: Inglês

10.1016/s0193-953x(05)70097-6

1558-3147

Nael Kilzieh, Hagop S. Akiskal,

Schizophrenia research and treatment

At times the malady begins with a closed series of very short attacks following very quickly one after the other … that is especially the case in a small group of youthful patients, preferably, as it seems, women.KRAEPELIN62 Bipolar disorder is a chronic illness characterized by recurrent episodes of depression and mania or hypomania. Cycle length can range from years to only a few days or even hours. Rapid cycling (RC) was arbitrarily defined by Dunner and Fieve36 as having four or more full length affective episodes per year. This work, conducted at Columbia University, showed that RC was overrepresented in patients who had failed lithium. Subsequently, Koukopoulos et al61 in Rome and Wehr and Goodwin102 at the National Institute of Mental Health (NIMH) proposed that antidepressant use was involved in RC. Unipolar RC is extremely rare, and when it occurs, family history is positive for bipolar disorder.99 Hence the focus in this article is on rapid-cycling bipolar disorder (RCBD). Although there has been more attention paid to this topic in recent years, it was already described by Kraepelin62 as a temporary phase in the course of manic-depressive illness. This classic viewpoint is endorsed by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), which included RC as a specifier of longitudinal course8 rather than a specific mood disorder subtype. These criteria stipulate that episodes are demarcated by partial or full remission for at least 2 months or a switch to an episode of the opposite polarity. In practice this definition means that RCBD represents an alternation between major depression on the one hand and manic, hypomanic, or mixed episodes. Partial remission is not defined, thus increasing the possibility of including heterogeneous populations. This article focuses on demographics; putative risk factors, including hypothyroidism and antidepressants; family history; treatment; and outcome. Developments of the greatest clinical relevance are covered. For the early literature on RCBD, the reader is referred to Alarcon's masterful review.5 (Rapid-cycling can have early- and late-onset.45 Although it is not uncommonly seen in juvenile patients46, 55 and sometimes in elderly patients,26, 30, 75 these topics are covered elsewhere in this issue.)