Rapid Cycling Affective Disorder Research Articles

Rapid Cycling Affective Disorder

Rapid Cycling Affective Disorder

Estados mistos e quadros de ciclagem rápida no transtorno bipolar

Estados mistos foram esquecidos por quase um século e os modernos critérios diagnósticos operacionais do DSM-IV e da CID-10 os caracterizam como episódios simultâneos de síndromes depressiva e maníaca, denominados mania mista, mania disfórica ou depressão durante a mania. Estudos de validação têm investigado várias linhas de corte dos estados mistos maníacos, dependendo do número de sintomas depressivos presentes no episódio maníaco. Paralelamente, crescem evidências acerca da existência de estados mistos depressivos, anteriormente descritos por Kraepelin, caracterizados por episódios depressivos com pelo menos três sintomas maníacos. O conhecimento sobre a terapêutica é limitado, pois deriva de ensaios clínicos de pacientes em mania que incluíram sujeitos em estados mistos. A ciclagem rápida é um tipo de curso do transtorno bipolar, definida pela presença de pelo menos quatro episódios distintos de mania, hipomania, depressão ou misto durante um ano. O tratamento é difícil e inclui a identificação de fatores de risco, como hipotireoidismo e transtornos relacionados ao uso de substâncias. Tanto nos estados mistos como na ciclagem rápida, preconiza-se evitar antidepressivos, quando possível. Neste trabalho são apresentadas formas clínicas dos estados mistos e algoritmos para o tratamento seqüencial de estados mistos maníacos e da ciclagem rápida baseadas nas evidências disponíveis na literatura.

Rapid Cycling Affective Disorder Presenting as Challenging behaviour in a Service User with Mild Learning Disability – Case Report

(2004). Rapid Cycling Affective Disorder Presenting as Challenging behaviour in a Service User with Mild Learning Disability – Case Report. The British Journal of Development Disabilities: Vol. 50, No. 99, pp. 99-108.

Rapid cycling affective disorder: a descriptive study from North India

A series of 33 (4.29%) cases of rapid cycling affective disorder (RCAD ICD-10-DCR) out of a pool of 770 consecutive cases of ICD-10 affective disorder (AD) was collected over a period of 5 years. All cases of RCAD belonged to bipolar affective disorder. RCAD when compared with non-rapid cycling bipolar affective disorder (BPAD) revealed a significantly longer mean duration of illness, greater number of total episodes, greater number of hospitalizations and stronger family loading of bipolar affective disorder. These findings implicate RCAD as a severe form of bipolar affective disorder.

P-18-11 - Comparison between early- and late-onset rapid cycling affective disorders. -Clinical course and response to pharmacotherapy

P-18-11 - Comparison between early- and late-onset rapid cycling affective disorders. -Clinical course and response to pharmacotherapy

Rapid Cycling Disorders in Mentally Retarded Children.

Mentally retarded children and adolescents not infrequently develop affective disorders, including a pattern of rapid cycling bipolar disorder. From work with nonretarded adults this pattern is known to have a tendency to chronicity and treatment resistance. Among persons with mental retardation, such a pattern is often marked by periods of severe overexcitation and underexcitation, often producing serious caretaking stress. Generally, it has been difficult to make this diagnosis in persons with severe to profound mental retardation and other severe disabilities, and it is probably often missed. However, knowing which questions to ask may facilitate diagnosis. It is our hypothesis that a positive family history of affective disorder in the presence of brain dysfunction increases the risk of rapid cycling affective disorder. Treatment results so far are limited to case reports and open trials. Much more research needs to be done to identify predictors of bipolar disorder and rapid cycling, the extent to which findings from studies of adults without mental retardation apply, and the most effective methods of treatment.

Rapid cycling mania post head injury

AbstractA case of post traumatic rapid cycling unipolar mania is described in an individual with no apparent genetic predisposition to an affective disorder. A head injury is proposed as being causative. It is suggested that head injury should be included as a cause of rapid cycling affective disorder.

Chronobiological approach for treatment-resistant rapid cycling affective disorders

A subgroup of patients who experience four or more major mood swings per year has been identified as rapid cyclers (Dunner and Fieve 1974). This subgroup is now believed to account for a significant proportion of treatment-resistant bipolar patients. Such rapid cycling has been indicated to be not only exacerbated, but possibly caused by the use of conventional antidepressants such as tricyclics (Wehr and Goodwin 1979). We applied phototherapy and vitamin BL2 coadministration to two patients with nonseasonal rapid cycling affective disorders, whose manic-depressive phases were uncontrollable for several years by various combinations of mood stabilizers as well as thyroid hormone. After these chronobiological treatments, their sleepwake rhythms became normal and their manic-depressive episodes became markedly suppressed. We presented some characteristic findings in their biological rhythms, and also discussed the usefulness of the chronobiological approach for treatment-resistant rapid cyclers.

Rapid cycling in severely multidisabled children: A form of bipolar affective disorder?

A debilitating, regularly recurring, biphasic disorder is described in 6 severely multidisabled children. It was characterized by several days of lethargy, withdrawal, loss of abilities, irritability, and hypersomnolence followed or preceded by a high-energy state for several days during which the children slept very little, at times were euphoric, had improved mental ability, and were hyperactive. These cyclic episodes had been present for years but unexpectedly disappeared in one child. The etiology is unknown, in spite of detailed neurologic, metabolic, and endocrine investigations. All patients had family histories positive for affective disorder. Melatonin treatment helped to regulate the coexisting chronic sleep disorders of 3 children but failed to eliminate the cycles. Antiepileptic drug treatment, lithium, sedatives, stimulants, tranquilizers, and light therapy were largely ineffective. The children's symptoms and signs fit the diagnostic criteria of a bipolar affective illness, as it was modified for patients with associated neurologic disability; therefore, the patients appeared to have a unique disorder that closely resembles or is a variant of rapid cycling affective disorder.

A Case of Late Onset Rapid Cycling Affective Disorder: Changes in Sleep Pattern and Rectal Temperature in Manic and Depressive States

A Case of Late Onset Rapid Cycling Affective Disorder: Changes in Sleep Pattern and Rectal Temperature in Manic and Depressive States

Periodicity of episode occurrences in rapid cycling affective disorders

We analyzed the medical records of nine patients with severe rapid cycling affective disorders (RCAD), and determined the cycle of mania occurrences by calculating the period between two successive onsets of mania for each patient. Using the cycle as the index we devised a cycle-oriented diagram by dividing the observation period by the index cycle, and visually studied the mode of episode occurrences. In seven patients, the onset of mania generally followed the index cycle, but sometimes shifted from the day estimated by the index cycle. The shift seemed to be caused by a cycle other than the index cycle, which appeared temporarily in the course. The period between two successive onsets of mania was often several times longer than the index cycle length. In patients with RCAD, some sort of periodic rhythms may possibly control the course of episode occurrences on a continuing basis.

A case of late‐onset rapid cycling affective disorder

AbstractA case of late‐onset bipolar rapid cycling affective disorder of classical cycle length is presented. The aetiology and management of the disorder is discussed. The case adds to other evidence that the symptoms of affective disorder in old age are similar to those in younger patients.

Rapid Cycling Affective Disorder, New Treatments, Persisting Resistance

Rapid Cycling Affective Disorder, New Treatments, Persisting Resistance

Biologische Befunde bei Rapid-Cycling-Syndromen

A subgroup of bipolar affective psychoses is characterized as rapid cycling affective disorder with at least four affective episodes resp. two bipolar cycles per year, including cycles of 48 hours ("ultra-rapid-cycling"). We show that rapid cycling-syndromes but not ultra rapid cycling-syndromes are comparable to traditional cyclothymic psychoses with respect to psychopathology, sex distribution, age of onset, REM sleep parameters and neuroendocrinological findings. Rapid cycling-syndromes exhibit acute switches, a peculiar coherence of course and intensity and a atypical combination of depression and hypersomnia. Ultra rapid cycling-syndromes are psychopathologically closely linked to some hypo- und hyperphases of endogenous psychoses. Like seen through a window they represent phenomena of syndromal shifting and can be related to organic dienzephaloses. They verify experiences of the sleep deprivation therapy that show the most sensitive night time for shifting being that between 1 and 3 o'clock a.m. The meaning of the drug induced rapid cycling may be overrated. The differential diagnosis includes various symptomatic affective psychoses as well as catatonic schizophrenic syndromes. Pathogenetic ideas discuss disorders of the pituitary dienzephalic regulation.

Pseudomultiplicity: A Clinical Manifestation of Rapid Cycling Affective Disorder in Borderline Personality?

AbstractThe intriguing nature of rapid cycling in some affective disorder patients raises many differential diagnostic questions. On the basis of a clinical case study, the suggestion is made that rapid cycling affective disorder (RCAD) patients may present manifestations resembling a multiple personality disorder (MPD) because of a premorbid borderline personality. The clinical similarities between RCAD and borderline personality disorder (BPD) are pointed out and emphasis is placed on the role of the boderline's instability, anger, regression, and use of dissociative mechanisms to induce pseudomultiplicity. The existence of MPD as an autonomous clinical entity is examined. The therapeutic relevance of this differential diagnostic approach is also emphasized.

Rapid cycling in unipolar and bipolar affective disorders

To characterize the nature of rapid cycling affective disorders, the authors analyzed mood fluctuation patterns in 570 patients with affective disorders hospitalized in 1960, 1975, or 1985. Patients' records were rated for the frequency, duration, and complexity of distinct affective states. Very rapid mood fluctuations were absent among bipolar patients in 1960 but were evident in 1975 and 1985. In each year, bipolar patients displayed more frequent, complex, and mixed episodes than did unipolar patients. The results suggest that more frequent episodes occur among bipolar than unipolar patients and that very rapid switch processes have become more widespread for some bipolar patients.

The pharmacotherapeutic management of rapid cycling affective disorder: an update

AbstractIn the present work the author presents a literature update regarding the pharmacotherapeutic management of rapid cycling affective disorder. This phenomenon is characterized, according to Dunner and Fieve (1974), by the presence of at least four affective episodes per year. After a consideration of the clinical features of the disorder, which are in many respects similar to those of the ‘classic’ bipolar disorder, the author describes the different therapeutic strategies available to the psychiatrist. Withdrawal of antidepressant therapy and administration of lithium salts are likely to constitute the best initial approach. In case of treatment non-responsiveness, it is possible to consider the use of different drugs; for example, carbamazepine, sodium valproate, clorgyline, thyroid hormone. To date, the therapeutic management of rapid cyclers remains extremely difficult. Further studies, especially addressed to the aetiopathogenetic aspects of the disorder, are required.

Rapid cycling affective disorders in the mentally retarded

This article describes a group of 10 hospitalized, mentally retarded patients with rapid cycling affective disorders, including details of demography, pattern of illness, and response to an open trial of treatment with lithium and/or carbamazepine. Family histories of these patients revealed high rates of mental illness, including affective disorder and mental retardation. Men had an earlier onset of affective illness and rapid cycling than did women. Half of the patients showed partial or complete improvement on lithium alone or in combination with carbamazepine; those who responded to the combined treatment had more episodes of affective illness per year than those who did not. Rates of response to treatment and some clinical characteristics of these patients were similar to those of non-mentally retarded rapid cycling patients.

Drs. Wehr and Goodwin Reply

Back to table of contents Previous article Next article ArticleNo AccessDrs. Wehr and Goodwin ReplyTHOMAS A. WEHR, and FREDERICK K. GOODWINTHOMAS A. WEHRSearch for more papers by this author, and FREDERICK K. GOODWINSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.146.1.127AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Drs. Wehr and Goodwin Reply." American Journal of Psychiatry, 146(1), pp. 127–128 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByLight Therapy for Seasonal Affective Disorder in a Clinical Office SettingJournal of Psychiatric Practice, Vol. 16, No. 6Psychological Reports, Vol. 101, No. 7Journal of Cosmetic Dermatology, Vol. 5, No. 1Tetrahedron Letters, Vol. 44, No. 7The Journal of Nervous and Mental Disease, Vol. 191, No. 7Depression and its Relation to Light DeprivationThe Psychoanalytic Review, Vol. 89, No. 4Photochemistry and Photobiology, Vol. 76, No. 6Seasonal Variation of Violence in NorwayGunnar Morken, M.D., and Olav M. Linaker, M.D., Ph.D.1 October 2000 | American Journal of Psychiatry, Vol. 157, No. 10Cryptochrome: The Second Photoactive Pigment in the Eye and Its Role in Circadian PhotoreceptionAnnual Review of Biochemistry, Vol. 69, No. 1Season and SuicideCrisis, Vol. 21, No. 2Current Opinion in Psychiatry, Vol. 13, No. 6The Journal of Alternative and Complementary Medicine, Vol. 3, No. supplement 1Contemporary Family Therapy, Vol. 18, No. 4American Journal of Police, Vol. 15, No. 1Multicenter, placebo-controlled study of fluoxetine in seasonal affective disorder1 April 2006 | American Journal of Psychiatry, Vol. 152, No. 12Journal of Women's Health, Vol. 3, No. 6Comorbid panic disorder in patients with winter depression1 April 2006 | American Journal of Psychiatry, Vol. 150, No. 7Depressive symptoms and family history in seasonal and nonseasonal mood disorders1 April 2006 | American Journal of Psychiatry, Vol. 150, No. 3Endeavour, Vol. 16, No. 3Should postattack phenomena be included in the definition and description of a panic attack?1 April 2006 | American Journal of Psychiatry, Vol. 148, No. 12Seasonal worsening of bulimia nervosa1 April 2006 | American Journal of Psychiatry, Vol. 148, No. 12Low electrooculographic ratios in patients with seasonal affective disorder1 April 2006 | American Journal of Psychiatry, Vol. 148, No. 11The pharmacotherapeutic management of rapid cycling affective disorder: an update13 June 2014 | Irish Journal of Psychological Medicine, Vol. 7, No. 1 Volume 146Issue 1 January 1989Pages 127-128 Metrics PDF download History Published online 1 April 2006 Published in print 1 January 1989

Thyroid hormones in the treatment of affective disorders.

The experience of using thyroid hormones in affective disorders is summarized. This includes: 1) Using thyroid hormones alone in depression; 2) their combined use with tricyclic antidepressants; 3) addition of thyroid hormones to nontricyclic antidepressants; 4) the use of thyroid stimulating hormone; and 5) thyrotropin releasing hormone in depression. Suggested mechanisms of action are discussed. A special attention is paid to the place of thyroid hormones in the treatment of rapid cycling affective disorder.