Abstract
Introduction: Cycle patterns of bipolar disorders (BDs) have been previously shown to be associated with clinical characteristics and response to lithium salts. Here, we evaluated the distribution of different types of manic-depressive cycles in a large sample of patients with BD. The associations between a mania-depression-interval (MDI) course and depression-mania-interval (DMI) course with sociodemographic/clinical factors were also assessed in order to define specific clinical profiles. Methods: In this cross-sectional study, 806 patients with BD admitted to the Psychiatric Unit of San Luigi Gonzaga Hospital in Orbassano and Molinette Hospital in Turin, Italy, were recruited. Patients were grouped according to the following course patterns: MDI, DMI, continuous cycling (CC, <4 episodes/year without intervals), rapid cycling (RC, ≥4 episodes/year), and irregular (IRR) cycling. We compared several sociodemographic and clinical variables in an MDI versus DMI course by means of ANOVA and Pearson χ2 with Bonferroni correction. Results: Bipolar cycles were distributed as follows: 50.2% IRR course, 31.5% MDI course, 16% DMI course, 1.2% CC, and 1% RC. Compared to DMI course, patients with an MDI course were more often men, younger, with an earlier onset, a manic polarity onset, and more lifetime compulsory admissions. They were more frequently treated with lithium and antipsychotics. Patients with a DMI course had older age at diagnosis and at first mood-stabilizer treatment and were more often misdiagnosed with a major depressive disorder. These patients were more commonly treated with anticonvulsants, and they had more frequently failed treatment trials with lithium salts in the past. Conclusion: This study supports the utility of classifying BD according to their course patterns. This classification holds prognostic as well as therapeutic implications.
References
1.
Merikangas
KR
, Jin
R
, He
JP
, Kessler
RC
, Lee
S
, Sampson
NA
, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative
. Arch Gen Psychiatry
. 2011
;68
(3
):241
–51
. .2.
Coryell
W
, Solomon
D
, Turvey
C
, Keller
M
, Leon
AC
, Endicott
J
, et al. The long-term course of rapid-cycling bipolar disorder
. Arch Gen Psychiatry
. 2003
;60
(9
):914
–20
. .3.
Carvalho
AF
, Dimellis
D
, Gonda
X
, Vieta
E
, Mclntyre
RS
, Fountoulakis
KN
. Rapid cycling in bipolar disorder: a systematic review
. J Clin Psychiatry
. 2014
;75
(6
):e578
–86
. .4.
Costa Lda
S
, Alencar
ÁP
, Nascimento Neto
PJ
, dos Santos Mdo
S
, da Silva
CG
, Pinheiro Sde
F
, et al. Risk factors for suicide in bipolar disorder: a systematic review
. J Affect Disord
. 2015
;170
:237
–54
. .5.
Baillarger
JGF
. Note sur un genre de folie dont les accès sont caractérisés par deux périodes régulières, l’une de dépression et l’autre d’excitation
. Bull Acad Med
. 1854
;XIX
:340
.6.
Kraepelin
E
. Psychiatrie: Ein Kurzes Lehrbuch für Studierende und Ärzte
. 3rd ed. Leipzig, Germany
: J. A Barth
; 1889
..7.
Koukopoulos
A
, Reginaldi
D
, Laddomada
P
, Floris
G
, Serra
G
, Tondo
L
. Course of the manic-depressive cycle and changes caused by treatment
. Pharmakopsychiatr Neuropsychopharmakol
. 1980
;13
(4
):156
–67
.8.
Koukopoulos
A
, Reginaldi
D
, Girardi
P
, Tondo
L
. Course of manic-depressive recurrences under lithium
. Compr Psychiatry
. 1975
;16
:517
–24
.9.
Grof
E
, Haag
M
, Grof
P
, Haag
H
. Lithium response and the sequence of episode polarities: preliminary report on a Hamilton sample
. Prog Neuropsychopharmacol Biol Psychiatry
. 1987
;11
(2–3
):199
–203
. .10.
Haag
H
, Heidorn
A
, Haag
M
, Greil
W
. Sequence of affective polarity and lithium response: preliminary report on Munich sample
. Prog Neuropsychopharmacol Biol Psychiatry
. 1987
;11
(2–3
):205
–8
. .11.
Maj
M
, Pirozzi
R
, Starace
F
. Previous pattern of course of the illness as a predictor of response to lithium prophylaxis in bipolar patients
. J Affect Disord
. 1989
;17
(3
):237
–41
. .12.
Faedda
GL
, Baldessarini
RJ
, Tohen
M
, Strakowski
SM
, Waternaux
C
. Episode sequence in bipolar disorder and response to lithium treatment
. Am J Psychiatry
. 1991
;148
(9
):1237
–9
. .13.
Hui
TP
, Kandola
A
, Shen
L
, Lewis
G
, Osborn
DPJ
, Geddes
JR
, et al. A systematic review and meta-analysis of clinical predictors of lithium response in bipolar disorder
. Acta Psychiatr Scand
. 2019
;140
(2
):94
–115
. .14.
Koukopoulos
A
, Reginanldi
D
, Tondo
L
, Visioli
C
, Baldessarini
RJ
. Course sequences in bipolar disorder: depressions preceding of following manias or hypomanias
. J Affect Disord
. 2013
;151
:105
–10
.15.
Alda
M
, Manchia
M
. Personalized management of bipolar disorder
. Neurosci Lett
. 2018
;669
:3
–9
. .16.
Salagre
E
, Dodd
S
, Aedo
A
, Rosa
A
, Amoretti
S
, Pinzon
J
, et al. Toward precision psychiatry in bipolar disorder: staging 2.0
. Front Psychiatry
. 2018
;9
(9
):641
. .17.
Perugi
G
, De Rossi
P
, Fagiolini
A
, Girardi
P
, Maina
G
, Sani
G
, et al. Personalized and precision medicine as informants for treatment management of bipolar disorder
. Int Clin Psychopharmacol
. 2019
;34
(4
):189
–205
. .18.
American Psychiatric Association
. Diagnostic and statistical manual of mental disorders
. 5th ed. Washington, DC
: American Psychiatric Publishing
; 2013
..19.
Maj
M
. Clinical prediction of response to lithium prophylaxis in bipolar patients: the importance of the previous pattern of course of the illness
. Clin Neuropharmacol
. 1990
;13
(Suppl 1
):S66
–70
. .20.
Baldessarini
RJ
, Tondo
L
, Visioli
C
. First-episode types in bipolar disorder: predictive associations with later illness
. Acta Psychiatr Scand
. 2014
;129
(5
):383
–92
. .21.
Koukopoulos
A
, Sani
G
, Koukopoulos
A
, Girardi
P
. Cyclicity and manic-depressive illness
. In: Marneros
A
, Angst
J
, editors. Bipolar disorders: 100 years after manic-depressive insanity
. Dordrecht, Germany
: Kluwer Academic Publishers
; 2000
. p. 315
–34
..22.
Perugi
G
, Restuccia
G
. I cicli rapidi nel disturbo bipolare
. Giorn Ital Psicopatol
. 2005
;11
:138
–50
.23.
Koukopoulos
A
, Sani
G
, Koukopoulos
AE
, Albert
MJ
, Girardi
P
, Tatarelli
R
. Endogenous and exogenous cyclicity and temperament in bipolar disorder: review, new data and hypotheses
. J Affect Disord
. 2006
;96
(3
):165
–75
. .24.
Azorin
JM
, Kaladjian
A
, Adida
M
, Hantouche
EG
, Hameg
A
, Lancrenon
S
, et al. Factors associated with rapid cycling in bipolar I manic patients: findings from a French national study
. CNS Spectr
. 2008
;13
(9
):780
–7
. .25.
Gao
K
, Kemp
DE
, Ganocy
SJ
, Muzina
DJ
, Xia
G
, Findling
RL
, et al. Treatment-emergent mania/hypomania during antidepressant monotherapy in patients with rapid cycling bipolar disorder
. Bipolar Disord
. 2008
;10
(8
):907
–15
. .26.
Valenti
M
, Pacchiarotti
I
, Undurraga
J
, Bonnín
CM
, Popovic
D
, Goikolea
JM
, et al. Risk factors for rapid cycling in bipolar disorder
. Bipolar Disord
. 2015
;17
:549
–59
.27.
Köhler
S
, Friedel
E
, Stamm
T
. Rapid cycling in bipolar disorders: symptoms, background and treatment recommendations
. Fortschr Neurol Psychiatr
. 2017
;85
:199
–211
.28.
Bauer
MS
, Whybrow
PC
, Winokur
A
. Rapid cycling bipolar affective disorder. I. Association with grade I hypothyroidism
. Arch Gen Psychiatry
. 1990
;47
(5
):427
–32
. .29.
Perugi
G
, Micheli
C
, Akiskal
HS
, Madaro
D
, Socci
C
, Quilici
C
, et al. Polarity of the first episode, clinical characteristics, and course of manic depressive illness: a systematic retrospective investigation of 320 bipolar I patients
. Compr Psychiatry
. 2000
;41
(1
):13
–8
. .30.
Baldessarini
RJ
, Salvatore
P
, Khalsa
HM
, Gebre-Medhin
P
, Imaz
H
, González-Pinto
A
, et al. Morbidity in 303 first-episode bipolar I disorder patients
. Bipolar Disord
. 2010
;12
(3
):264
–70
. .31.
Baldessarini
RJ
, Salvatore
P
, Khalsa
H-MK
, Tohen
M
. Dissimilar morbidity following initial mania vs. mixed-states in type-I bipolar disorder
. J Affect Disord
. 2010
;126
:299
–302
.32.
Baldessarini
RJ
, Undurraga
J
, Vázquez
GH
, Tondo
L
, Salvatore
P
, Ha
K
, et al. Predominant recurrence polarity among 928 adult international bipolar I disorder patients
. Acta Psychiatr Scand
. 2012
;125
(4
):293
–302
. .33.
Tundo
A
, Calabrese
JR
, Marchetti
F
, Dell’Osso
L
, Proietti
L
, De Filippis
R
. Continuous circular cycling in bipolar disorder as a predictor of poor outcome
. J Affect Disord
. 2013
;150
(3
):823
–8
. .34.
Hunt
GE
, Malhi
GS
, Cleary
M
, Lai
HM
, Sitharthan
T
. Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: systematic review and meta-analysis
. J Affect Disord
. 2016
;206
:331
–49
. .35.
Goldberg
JF
, Ernst
CL
. Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder
. J Clin Psychiatry
. 2002
;63
(11
):985
–91
. .36.
Altamura
AC
, Dell’Osso
B
, BerlinBuoli
HAM
, Buoli
M
, Bassetti
R
, Mundo
E
. Duration of untreated illness and suicide in bipolar disorder: a naturalistic study
. Eur Arch Psychiatry Clin Neurosci
. 2010
;260
(5
):385
–91
. .37.
Drancourt
N
, Etain
B
, LajnefHenry
MC
, Henry
C
, Raust
A
, Cochet
B
, et al. Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment
. Acta Psychiatr Scand
. 2013
;127
(2
):136
–44
. .38.
Maina
G
, Bechon
E
, Rigardetto
S
, Salvi
V
. General medical conditions are associated with delay to treatment in patients with bipolar disorder
. Psychosomatics
. 2013
;54
(5
):437
–42
. .39.
Maciukiewicz
M
, Pawlak
J
, Kapelski
P
, Łabędzka
M
, Skibinska
M
, Zaremba
D
, et al. Can psychological, social and demographical factors predict clinical characteristics symptomatology of bipolar affective disorder and schizophrenia?
Psychiatr Q
. 2016
;87
(3
):501
–13
. .40.
Salvi
V
, D’Ambrosio
V
, Bogetto
F
, Maina
G
. Metabolic syndrome in Italian patients with bipolar disorder: a 2-year follow-up study
. J Affect Disord
. 2012
;136
(3
):599
–603
. .41.
Salvi
V
, Barone-Adesi
F
, D’Ambrosio
V
, Albert
U
, Maina
G
. High H1-affinity antidepressants and risk of metabolic syndrome in bipolar disorder
. Psychopharmacology
. 2016
;233
(1
):49
–56
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