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Paper Information

Journal:   IRANIAN JOURNAL OF PSYCHIATRY AND CLINICAL PSYCHOLOGY   FALL 2010 , Volume 16 , Number 3 (62); Page(s) 303 To 303.
 
Paper: 

RAPID CYCLING BIPOLAR DISORDER

 
 
Author(s):  SANI G., KOUKOPOULOS A.
 
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Abstract: 

Currently, there is no consensus on the definition of rapid cycling course in bipolar disorders. For the DSM-IV, it is a course specifier applicable to both bipolar I and II diagnoses; as in the Dunner and Fieve classical definition of 1974, the DSM-IV includes a number of episodes cut-off criterion during the past twelve months, which is set at four. Major areas of controversy include duration of episodes and intercritical period, stability of the RC course, relationship with drug intake, treatment response and outcome.
The duration of episode criterion is often waived for research purposes in various studies, but periods of 4 days to one week are variously accepted for a hypomanic episode. The duration of intercritical periods are also variable from 2 weeks to 2 months, but a symptom-free period lasting at least as far as the index episode has also been proposed. Furthermore, no intercritical period is required in case of switch to the opposite polarity. This problem of definition may lead to an underestimation of rapid cyclicity.
The relationship to drug intake is highly debated; it appears that all antidepressant drug classes are involved, but tricyclics fare worse than the other classes.
Rapid cyclicity, either spontaneous or induced, once established, becomes a special and stable  rhythm, linked to endogenous and environmental factors.
Although the presence of a rapid cycling course is more often associated with treatment resistance, there are no strong data to suggest that such patients show poor response to lithium, as has often been claimed.
The outcome of a patient with a rapid cycling course is not necessarily worse, but has a higher probability to be so. Antidepressant drugs should be avoided or, if it is not possible, they should be cautiously used in such patients, at low doses and for a period of time as short as possible. The combination with mood stabilizers is always recommended. It is extremely important to avoid  inducing the onset of rapid cyclicity and to treat it adequately as soon as possible.
In order to contribute to the debate, we examined clinical data of 2540 patients treated at Lucio Bini Center of Roma between January 1st 1998 and December 31st 2008. Among these patients, 1032 (40.6%) have the diagnosis of Bipolar Disorder or Cyclothymic Disorder. Rapid cyclers are 160 (15.5%). In 80% of cases, the onset of rapid cyclicity is associated with the use of antidepressants or other stimulant agents.  The time of illness before the onset of rapid cyclicity has a mean duration of 11.7 years, while the mean duration of rapid cyclicity is 7.5 years.
After a follow-up period of at least 6 months,  31 patients (35.3%) are completely remitted, 24 (27.3%) are non-responders, and 13 (14.8%)  continue to present rapid cyclicity with episodes of milder severity. The presence of agitated depression or mixed states makes the prognosis less favorable.

 
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References: 
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Cite:
APA: Copy

SANI, G., & KOUKOPOULOS, A. (2010). RAPID CYCLING BIPOLAR DISORDER. IRANIAN JOURNAL OF PSYCHIATRY AND CLINICAL PSYCHOLOGY, 16(3 (62)), 303-303. https://www.sid.ir/en/journal/ViewPaper.aspx?id=194421



Vancouver: Copy

SANI G., KOUKOPOULOS A.. RAPID CYCLING BIPOLAR DISORDER. IRANIAN JOURNAL OF PSYCHIATRY AND CLINICAL PSYCHOLOGY. 2010 [cited 2021April23];16(3 (62)):303-303. Available from: https://www.sid.ir/en/journal/ViewPaper.aspx?id=194421



IEEE: Copy

SANI, G., KOUKOPOULOS, A., 2010. RAPID CYCLING BIPOLAR DISORDER. IRANIAN JOURNAL OF PSYCHIATRY AND CLINICAL PSYCHOLOGY, [online] 16(3 (62)), pp.303-303. Available: https://www.sid.ir/en/journal/ViewPaper.aspx?id=194421.



 
 
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