Rapid Cycling Bipolar Disorder Research Articles

Electroconvulsive Therapy (ECT) in Bipolar Disorder Patients with Ultra-Rapid Cycling and Unstable Mixed States.

Background and Objectives: Unstable mixed episodes or rapid switching between opposite affective poles within the scope of short cycles was first characterized in 1967 by S. Mentzos as complex polymorphous states with chaotic overlap of manic and depressive symptoms. Well-known examples include antidepressant-induced mania/hypomania and rapid/ultra-rapid/ultradian cycling, when clinicians observe an almost continuous mixed state with a constant change of preponderance of manic or depressive symptoms. Achieving stable remission in these cases is challenging with almost no data on evidence-based treatment. When mood stabilizers are ineffective, electroconvulsive therapy (ECT) has been suggested. Objectives: After reviewing the evidence from available literature, this article presents our own clinical experience of ECT efficacy and tolerability in patients with ultra-rapid cycling bipolar disorder (BD) and unstable mixed states. Materials and Methods: We conducted an open, one-year observational prospective study with a “mirror image” design, including 30 patients with rapid and ultra-rapid cycling BD on long-term mood stabilizer treatment (18 received lithium carbonate, 6 on valproate and 6 on carbamazepine) with limited effectiveness. A bilateral ECT course (5–10 sessions) was prescribed for regaining mood stability. Results: ECT was very effective in 12 patients (40%) with a history of ineffective mood stabilizer treatment who achieved and maintained remission; all of them received lithium except for 1 patient who received carbamazepine and 2 with valproate. Nine patients (30%) showed partial response (one on carbamazepine and two on valproate) and nine patients (30%) had no improvement at all (four on carbamazepine and two on valproate). For the whole sample, the duration of affective episodes was significantly reduced from 36.05 ± 4.32 weeks in the year prior to ECT to 21.74 ± 12.14 weeks in the year post-ECT (p < 0.001). Depressive episodes with mixed and/or catatonic features according to DSM-5 specifiers were associated with a better acute ECT response and/or long-term mood stabilizer treatment outcome after ECT. Conclusions: ECT could be considered as a useful option for getting mood instability under control in rapid and ultra-rapid cycling bipolar patients. Further randomized trials are needed to confirm these results.

High-Dose Levothyroxine for Bipolar Disorder; the Potential Role of Thyroid Function and Genetic Tests. Report from Twenty Cases.

Rationale: Rapid Cycling Bipolar Disorder (RCBPD) is a malignant course of bipolar disorder (BPD). The condition is associated with several co-morbidities and is difficult to treat. Supra- physiologic doses of levothyroxine (average 482 µg/day) (High-Dose Levothyroxine, HDL) have proven effective for treatment resistant BPD. It is unclear exactly how HDL benefits patients with BPD. Objectives: In this paper, we present the retrospective analysis of clinical notes of 20 patients in remission from RCBPD for at least six months, who received HDL (150-1000 µg; median 472 µg/day). We examine the role of Thyroid function tests (TFTs) and genetic testing. We aim to demonstrate the utility of these tests for patient selection and response prediction for HDL. Findings: All patients recovered with minimal side effects with no treatment discontinuations. One patient required a dose reduction because of palpitations and sweating. Seventeen patients had concomitant Repetitive Transcranial Magnetic Stimulation (rTMS). Ten patients (50%) required one psychotropic in the acute phase, two patients (10%) required two and eight patients (40%) required only HDL. Following remission, 11 patients (55%) were on HDL only. The average pre-treatment ratio of free T4 (thyroxine, fT4): free T3 (triiodothyronine, fT3) was 4:1, with fT4 increasing post-treatment to 5:1 while fT3 remained largely normal. Nineteen patients had single nucleotide polymorphism (SNPs) of DIO1, DIO2 , or both. One subject requiring 400 µg had a SNP in the SLCO1C1 thyroid carrier. A high fT4:fT3 noted as early as day 10 during treatment supports a role for DIO polymorphisms. Conclusions: This preliminary report demonstrates the usefulness of a high fT4/fT3 ratio in the second week as a predictive test for patient selection and response prediction for HDL. Recently we have developed a treatment protocol combining HDL and rTMS.

Gender differences in the clinical course of depression in bipolar disorder

Objective: to investigate gender differences in patients with depression and bipolar disorder (BD) and their impact on the clinical course of the disease. Patients and methods . 50 women and 50 men with bipolar disorder (BD) (F31 according to the International Classification of Diseases, 10 th revision – ICD-10) were examined using a specially developed survey. Patients symptoms was assessed in accordance with the diagnostic criteria of affective disorders according to ICD-10 and DSM-V, MADRS (Montgomery-Asberg Depression Rating Scale) and Q-LES-Q-SF (Scoring the Quality of Life Enjoyment and Satisfaction Questionnaire). Results and discussion . Gender differences in the clinical course of BP were revealed. In men the disease usually starts with a mania phase followed by a marked mood increase in BD- I, a shorter period before the first mania (hypomania) if the onset is with the depression phase, mood swings and substance use disorders in puberty, which makes the diagnosis easier. In women BD diagnosis may be harder due to higher frequency of BD-II, clinical presentation with depression, longer period before the first mania (hypomania). Therefore the most important clinical markers of BD in women include the early onset of the disease, its association with neurohormonal factors, history of affective variability, substance use disorders, schizophrenia, hereditary or comorbid eating disorder in puberty or later in life. The most common clinical features during the depression phase in men include: seasonal fluctuation (worsening of symptoms in autumn and winter) and diurnal variations (improvement of symptoms in the evening), numbed emotions, depersonalization-derealization syndrome, decreased libido, difficulty in falling asleep and increased appetite and/or body mass, comorbid depression, panic attacks and alcohol and substance abuse. The depression in women with BD is characterized by a higher prevalence of apathy, tearfulness, self-harm, body dysmorphic disorder, decreased appetite. Both male and female patients with depression and BD have a high level of anxiety, presence of psychomotor retardation, self-accusation and irritancy, 10% had atypical features according to the DSM-V criteria. Women have a higher proportion of depressive episodes (including rapid cycling BD) and a higher risk of suicidal behavior, and men, due to a higher frequency of manic phases, change partners and have a history of divorce significantly more often. Conclusion. The revealed features of psychopathological symptoms, comorbid disorders, the course of the disease and correlations between individual characteristics and factors due to gender differences, can be used as markers of bipolarity, which will allow to diagnose BD earlier and more accurately and prescribe adequate therapy.

Clinical and evolutionary features of bipolar disorder in women

IntroductionBipolar female patients have clinical and evolutionary features wich involve different factors related to the women specifities.Objectives Establish clinical and evolutionary features in a population of bipolar female patients attending to Gabes psychiatry department.MethodsA retrospective descriptive and analytical study was undertaken including female patients referred to psychiatry department of Gabes regional hospital, for the first time in a 6-year period (January 1st, 2010 to December 31, 2016) and who were already diagnosed with bipolar disorder (BD). Sociodemographic, clinical and evolutionary data were assessed. Patients were divised into two groups according to gender. The collected data were compared between the two groups. The statistical analysis was executed on the software SPSS (20th edition).ResultsFrom the 193 bipolar patients, 103 were women. The mean age of the disorder’s onset amongst Female patients was 32.4 years old [14 - 63]. The mean duration of the disorder was 7.6 years [2 - 30]. The polarity of the first episode was a depressive one in 74.7% of cases. It was associated to psychotic features in 43.7% of cases. Seasonal pattern was noted in 10.6% amongst female patients and rapid cycling bipolar disorder in 6.2% of cases. Analytical study showed that women began the BD more often with a depressive episode (p=0.004) and were more frequently diagnosed with BD type 2 (p&lt;0.001). Men had significantly more auditory (p=0.002) and visual hallucinations (p=0.019).ConclusionsThere were clinical specifities of women with BD from which important to be considered.

The case for and against selective serotonin reuptake inhibitors in rapid cycling bipolar disorder

Patients affected by the rapid cycling variant of bipolar disorder often experience significant functional difficulties. Physicians caring for affected patients face many challenges managing the turbulent course of this disorder, complicated at times by psychiatric comorbidities (including substance use disorders), polypharmacy, risk management (of suicidality and aggression), and difficulties with community functioning. There is some controversy about the use of selective serotonin receptor inhibitors (SSRIs) in managing bipolar depression, particularly in the rapid cycling variant. The potential benefit of SSRIs in reducing depressive symptoms must be balanced against the risks of mood phase switching and overall worsening of the rapid cycling course. This case report highlights challenges inherent in the application of SSRIs in a case of treatment-refractory rapid cycling bipolar disorder, and discusses the controversy of their use.

Efficacy and safety of lamotrigine in the treatment of bipolar disorder across the lifespan: a systematic review.

Background:Bipolar disorder (BD) is a cyclic mood disorder characterised by alternating episodes of mania/hypomania and depression interspersed with euthymic periods. Lamotrigine (LTG) demonstrated some mood improvement in patients treated for epilepsy, leading to clinical studies in patients with BD and its eventual introduction as maintenance therapy for the prevention of depressive relapse in euthymic patients. Most current clinical guidelines include LTG as a recommended treatment option for the maintenance phase in adult BD, consistent with its global licencing status.Aims:To review the evidence for the efficacy and safety of LTG in the treatment of all phases of BD.Methods:PubMed was searched for double-blind, randomised, placebo-controlled trials using the keywords: LTG, Lamictal, ‘bipolar disorder’, ‘bipolar affective disorder’, ‘bipolar I’, ‘bipolar II’, cyclothymia, mania, manic, depression, depressive, ‘randomised controlled trial’, ‘randomised trial’, RCT and ‘placebo-controlled’ and corresponding MeSH terms. Eligible articles published in English were reviewed.Results:Thirteen studies were identified. The strongest evidence supports utility in the prevention of recurrence and relapse, particularly depressive relapse, in stabilised patients. Some evidence suggests efficacy in acute bipolar depression, but findings are inconsistent. There is little or no strong evidence in support of efficacy in acute mania, unipolar depression, or rapid-cycling BD. Few controlled trials have evaluated LTG in bipolar II or in paediatric patients. Indications for safety, tolerability and patient acceptability are relatively favourable, provided there is slow dose escalation to reduce the probability of skin rash.Conclusion:On the balance of efficacy and tolerability, LTG might be considered a first-line drug for BD, except for acute manic episodes or where rapid symptom control is required. In terms of efficacy alone, however, the evidence favours other medications.

Dissecting clinical heterogeneity of bipolar disorder using multiple polygenic risk scores

Bipolar disorder (BD) has high clinical heterogeneity, frequent psychiatric comorbidities, and elevated suicide risk. To determine genetic differences between common clinical sub-phenotypes of BD, we performed a systematic polygenic risk score (PRS) analysis using multiple PRSs from a range of psychiatric, personality, and lifestyle traits to dissect differences in BD sub-phenotypes in two BD cohorts: the Mayo Clinic BD Biobank (N = 968) and Genetic Association Information Network (N = 1001). Participants were assessed for history of psychosis, early-onset BD, rapid cycling (defined as four or more episodes in a year), and suicide attempts using questionnaires and the Structured Clinical Interview for DSM-IV. In a combined sample of 1969 bipolar cases (45.5% male), those with psychosis had higher PRS for SCZ (OR = 1.3 per S.D.; p = 3e-5) but lower PRSs for anhedonia (OR = 0.87; p = 0.003) and BMI (OR = 0.87; p = 0.003). Rapid cycling cases had higher PRS for ADHD (OR = 1.23; p = 7e-5) and MDD (OR = 1.23; p = 4e-5) and lower BD PRS (OR = 0.8; p = 0.004). Cases with a suicide attempt had higher PRS for MDD (OR = 1.26; p = 1e-6) and anhedonia (OR = 1.22; p = 2e-5) as well as lower PRS for educational attainment (OR = 0.87; p = 0.003). The observed novel PRS associations with sub-phenotypes align with clinical observations such as rapid cycling BD patients having a greater lifetime prevalence of ADHD. Our findings confirm that genetic heterogeneity contributes to clinical heterogeneity of BD and consideration of genetic contribution to psychopathologic components of psychiatric disorders may improve genetic prediction of complex psychiatric disorders.

Rapid cycling bipolar disorder is associated with antithyroid antibodies, instead of thyroid dysfunction

BackgroundConclusions regarding the association between antithyroid antibodies or thyroid dysfunction and rapid cycling bipolar disorder (RCBD) have been conflicting. Previous studies suggest that the impact of antithyroid antibodies on mental wellbeing seems to be independent of thyroid function. Here, we investigated their independent association with RCBD in a large, well-defined population of bipolar disorder (BD).MethodsFast serum levels of free thyroxine (FT4), free triiodothyronine (FT3), thyroid Stimulating Hormone (TSH), TPO-abs and Tg-abs were simultaneously measured in 352 patients with BD. Clinical features of BD were collected through semi-structural interview conducted by trained interviewers with background of psychiatric education.ResultsNeither hypothyroidism nor hyperthyroidism was significantly associated with RCBD. Both TPO-abs and Tg-abs were significantly related to RCBD, even after controlling for gender, age, marriage status, education, antidepressants treatment, comorbidity of thyroid diseases, and thyroid function (serum levels of FT3, FT4 and TSH). Although TPO-abs and Tg-abs were highly correlated with each other, binary logistic regression with forward LR selected TPO-abs, instead of Tg-abs, to be associated with RCBD. TPO-abs was significantly, independently of Tg-abs, associated with hyperthyroidism, while Tg-abs was marginally significantly related to hypothyroidism at the presence of TPO-abs.ConclusionTPO-abs might be treated as a biomarker of RCBD. Further exploring the underlying mechanism might help understand the nature of RCBD and find out new treatment target for it.

Commentary on "Synchrony Between Bipolar Mood Cycles and Lunar Tidal Cycles Ended After Initiation of Light Treatment and Treatment of Hypothyroidism".

According to a recent report, mood cycles in a group of patients with rapid cycling bipolar disorder oscillated in synchrony with lunar gravimetric tides. Mood switches in a 67-year-old woman with rapid cycling bipolar II disorder on lithium maintenance treatment were assessed with a χ periodogram and a χ analysis of the mood switches in relation to the lunar tidal cycle. During a period when she was treated with nortriptyline and her thyroid-stimulating hormone levels were elevated, her mood switches had a significant (P<0.05) 29- to 30-day periodicity, and the χ analysis showed that the switches were distributed nonrandomly in relation to the spring-neap lunar tidal cycle (P<0.0001); 14 of 15 switches occurred within 2 days of the spring tides. After nortriptyline was discontinued, thyroid-stimulating hormone levels were normalized with treatment with levothyroxine, and consistent bright light treatment was started, the synchrony between mood cycles and lunar cycles disappeared, and rapid cycling eventually stopped. The possibility that lunar mood cycling is sometimes contingent on antidepressant treatment, decreased thyroid function, and certain types of light-dark cycles needs to be considered in future research on lunar tidal influences on the course of bipolar illness.

Adjunctive thyroid hormone treatment in rapid cycling bipolar disorder: A double-blind placebo-controlled trial of levothyroxine (L-T4) and triiodothyronine (T3).

Adjunctive thyroid hormone treatment in rapid cycling bipolar disorder: A double-blind placebo-controlled trial of levothyroxine (L-T4) and triiodothyronine (T3).

Correlates of current rapid-cycling bipolar disorder: Results from the Italian multicentric RENDiBi study

Backgroundwe aimed to compare socio-demographic and clinical differences between patients with versus without current RC in order to detect clinical factors that may favor early diagnosis and personalized treatment. MethodsA total of 1675 patients (males: n = 714 and females: n = 961; bipolar 1: n = 1042 and bipolar 2: n = 633) from different psychiatric clinics were grouped and compared according to the current presence of RC in terms of socio-demographic and clinical variables. Chi-squared tests for qualitative variables and Student’s t tests for quantitative variables were executed for group comparison, and multivariable logistic regressions were performed, considering the current presence of RC as dependent variable, and socio-demographic/clinical factors as independent variables. ResultsFemale gender (male versus female: OR = 0.64, p = 0.04), unidentifiable prevalent polarity (versus depressive polarity: OR = 1.76, p = 0.02; versus manic polarity: OR: 2.86, p < 0.01) and hospitalization in the last year (no versus yes: OR = 0.63, p = 0.02) were found to be associated with RC in the final multivariable regression analysis. ConclusionsRC in BD seems to be more prevalent in female gender and associated with some unfavorable clinical features, such as an increased risk of hospitalization. These aspects should be taken into account in the management and monitoring of RC versus non-RC patients.

A cross-sectional study comparing some clinical features of patients with rapid cycling and non-rapid cycling bipolar disorder

Objective: Literature indicates that rapid cycling (RC) feature in bipolar disorder (BD) has been associated with worse disorder outcome and more severe disability. We aimed to investigate factors that affect or involved in vulnerability to increase rapid cycling in the previous 12 months. Methods: This is a cross-sectional study. Patients (n=380) were recruited from an outpatients clinic of a general hospital. Diagnostic interviews were performed with Structured Clinical Interview for DSM-IV Disorders (SCID-I) and SCID-II. Sociodemographic Form, Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HAM-D) were applied. RC was defined as presence four or more mood episodes in the previous 12 months. Patients were arranged as whether having rapid cycling bipolar disorder (RCBD) or not. RCBD was compared to the group of non-RCBD patients regarding the sociode-mographic and clinical data. Results: Study group showed a female preponderance (65.0%). Sixty patients (15.8%) had RC in the previous 12 months. There were statistically significant differences between two groups regarding in number of suicide attempts, family history of mood disorders, psychotic depression, number of antidepressants utilized, manic, depressive, mixed and total number of episodes. Discussion: The presence of RC in the previous 12 months was found correlated with specific clinical features closely related to worse outcome in the course of BD. Further studies are needed to clarify disease-related factors in patient groups with a standard definition of homo-geneous RCBD.

The Role of Clozapine as a Mood Regulator in the Treatment of Rapid Cycling Bipolar Affective Disorder

In this study, we aimed to investigate the effect of the clozapine on the course of the rapid cycling Bipolar Affective Disorder. The study group was formed with the patients aged between 18 and 65 years of age, who met the criteria for the diagnosis of Bipolar Affective Disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition, with rapid cycling characteristics. Variables like the number of mania and depressive episodes, the days spent in mania and in depression and the number of hospitalization and attempted suicide, in the year before starting clozapine were determined and compared with the annual data after starting the clozapine. Eleven female and two male patients who met the inclusion criteria were included in this study. The group`s average daily use of clozapine was 180 mg (25-600 mg). There was a statistically significant difference in the number of days spent in the depression, the days spent in the mania, the number of depressive episodes and manic episodes, the number of hospitalizations and the suicide attempts after the clozapine use. In this study, it was determined that clozapine was effective as a mood stabilizer in Bipolar Affective Disorder treatment. The results show that clozapine reduces the episode frequency and the duration in rapid cycling Bipolar Affective Disorder which does not respond to all conventional treatments, including lithium, valproic acid, carbamazepine and antipsychotic drugs.

Clozapine as a mood stabilizer in the treatment of rapid cycling bipolar affective disorder

Chronic treatment with the atypical antipsychotics clozapine has been associated with an increased risk for deterioration of glucose homeostasis, leading to hyperglycemia and insulin resistance diabetes. The present study mainly aimed to investigate possible mechanisms underlying clozapine-induced hyperglycemia. Male Wistar albino rats were randomly divided into two groups (each consists of 12 rats). The first group received clozapine orally at a dose of 10 mg/kg body weight daily for 6 weeks, while the other group received the drug vehicle only and served as the control group. At the end of the six weeks, hyperglycemia, hyperinsulinemia and insulin resistance, as indicated by Homeostatic model assessment of insulin resistance (HOMA-IR), were observed in the clozapine group as compared with the control group. This disturbance in glucose regulation was associated with non-significant changes in body weight, serum cortisol level, and hepatic glycogen content. The Clozapine group showed a significant increase in hepatic phosphorylase activity and in the gene expression level of hepatic glucose-6-phosphatse (G6Pase) enzymes compared to the control group. It can be concluded that clozapine-induced hyperglycemia and insulin resistance occur in a manner mostly independent of weight gain, and may be attributed to an increase in hepatic phosphorylase activity and increased expression level of G6Pase.

Hypothesis: Folklore perpetuated expression of moon-associated bipolar disorders in anecdotally exaggerated werewolf guise

We hypothesize that Moon-associated signals, recently linked to rapid cycling bipolar disorder, may have triggered extremely rare instances of extreme manic and aggressive behaviour that may be compatible with the folklore of the werewolf. Very limited literature on instances of clinical lycanthropy or violent/manic/madness behaviour in association with the Moon may be due to very rare lycanthropic psychosis and not knowing which signal(s) could determine Moon-mood associations. Mechanistically, lunar effects related to bipolar disorder, mood changes, and psychosis could involve either, or a combination, of the following: (i) some as of yet non-measurable signal or undefined geoelectric/geomagnetic receptor or higher sensitivity in some humans, (ii) Moonlight affecting sleep and/or circadian rhythm, (iii) perinatal imprinting of susceptibility, (iv) lunar-periodic growth, and subsequent consumption, of or exposure to psychotropic agents. Importantly, remarkable recent studies (2018) suggest that links between some Moon cycles and bipolar disorder are conceivable. Further observations suggest a role for periodic changes in lunar distances in combination with the Earth and Sun positions. Targeted research could use insight from astrophysicists. If causal links between Moon signals and mood were corroborated, sufferers may benefit from improved disease understanding. Herein, we systematically review the literature and synthesize the evidence for and against the hypothesis. The werewolf myth could become another instance of folklore popularizing biological variation worthy of investigation such as the book characters created by the psychiatrist Hoffmann in 1845 as a Christmas present for his son; namely, ‘Struwelpeter’ and ‘Zappel-Philipp’ (shock-headed Peter and fidgety-Philipp): Their conspicuous characteristics have since been linked to genetic uncombable hair syndrome and ADHD, respectively. Overall, rather than dismissing (seemingly) trivial and uncertain concepts as ‘just folklore’, scientists should grapple with the roots, causes, and significance of traditions and tales, including the werewolf legend.

Medication nonadherence in bipolar disorder: a narrative review.

A number of effective maintenance medication options exist for bipolar disorder (BD) and these are regarded as the foundation of long-term treatment in BD. However, nonadherence to medication is common in BD. For example, a large data base study in the United States of America (USA) showed that approximately half of patients with BD were nonadherent with lithium and maintenance medications over a 12 month period. Such nonadherence carries a high risk of relapse due to the recurrent nature of the illness and the fact that abrupt cessation of treatment, particularly lithium, may cause rebound depression and mania. Indeed, medication nonadherence in BD is associated with significantly increased risks of relapse, recurrence, hospitalization and suicide attempts and a decreased likelihood of achieving remission and recovery, as well as with higher overall treatment costs. Factors associated with nonadherence include adverse effects of medication, complex medication regimens, negative patient attitudes to medication, poor insight, rapid-cycling BD, comorbid substance misuse and a poor therapeutic alliance. Clinicians should routinely enquire about nonadherence in a nonjudgmental fashion. Potential steps to improve adherence include simple pragmatic strategies related to prescribing including shared decision-making, psychoeducation with a clear focus on adherence, reminders (traditional and digital), potentially using a depot rather than an oral antipsychotic, managing comorbid substance misuse and improving therapeutic alliance. Financial incentives have been shown to improve adherence to depot antipsychotics, but this approach raises ethical issues and its long-term effectiveness is unknown. Often a combination of approaches will be required. The strategies that are adopted need to be patient specific, reflecting that nonadherence has no single cause, and chosen by the patient and clinician working together.

Clinical characterization of rapid cycling bipolar disorder: Association with attention deficit hyperactivity disorder

BackgroundRapid cycling (RC) bipolar disorder (BD) is associated with more disability and worse global functioning than non-rapid cycling BD (NRC) and is understudied. This study aims to investigate clinical characteristics associated to RC in a Latin-American sample and secondarily, to generate a clinical model to test the likelihood of RC in BD. Methods250 BD patients were enrolled between 2007 and 2015. All patients met DSM-IV criteria for BD type I, II or NOS. The sample was dichotomized into RC and NRC subgroups, and compared in terms of sociodemographic and clinical variables by bivariate analyses. A binary logistic regression was performed to generate a model and explain variance associated with the likelihood of presenting RC. ResultsFinal sample included 235 patients, of which forty-four (18.7%) met RC criteria. When compared to NRC, a significantly higher proportion of RC patients were female (81.4% vs. 58.9% p = 0.006), BD type II (58.1% vs. 29.7% p = 0.002), presented more manic/hypomanic episodes (43.6 ± 35.8 vs. 12.8 ± 58.9, p = 0.001), and had less psychotic symptoms (20.9% vs. 42.2%, p = 0.010). Attention deficit hyperactivity disorder (ADHD) was a significant comorbidity in RC (23.7% vs. 8.3%, p = 0.007). No differences were found in suicidality, mixed symptoms, and seasonal pattern. After logistic regression, variables significantly associated with RC were presence of ADHD (OR 4.6 [95% CI 1.54–13.93] p = 0.006) and female gender (OR 3.55 [95% CI, 1.32–9.56] p = 0.012). LimitationsIt is a cross-sectional study. ConclusionsFindings suggest that ADHD comorbidity, and female gender are risk factors for RC in BD.

Adjunctive thyroid hormone treatment in rapid cycling bipolar disorder: A double-blind placebo-controlled trial of levothyroxine (L-T4 ) and triiodothyronine (T3 ).

This report describes the first comparative double-blind, placebo-controlled trial of levothyroxine (L-T4 ) and triiodothyronine (T3 ) as adjunctive treatments in rapid cycling bipolar disorder. Thirty-two treatment-resistant, rapid cycling patients who had failed a trial of lithium were randomized into three treatment arms: L-T4 , T3 , or placebo. They were followed for ≥4months with weekly clinical and endocrine assessments. There were no statistically significant differences between the groups in age, gender, duration of illness, or thyroid status. Markov chain analyses were employed to assess treatment effects on cycling patterns among mood states (euthymia, depression, mania, and mixed). Within groups, post-treatment the L-T4 group spent significantly less time depressed or in a mixed state and greater time euthymic. The T3 and placebo groups did not differ significantly pre- and post-treatment in any mood state, although the pattern of effects was the same for the T3 group as for the L-T4 group. Between groups, the L-T4 group had a significantly greater increase in time euthymic and decrease in time in the mixed state than the placebo group. Other group differences were not significant, although they were in the expected direction. The findings in this first double-blind study directly comparing the effects of L-T4 and T3 therapy against placebo provide evidence for the benefit of adjunctive L-T4 in alleviating resistant depression, reducing time in mixed states and increasing time euthymic. Adjunctive T3 did not show statistically significant evidence of benefit over placebo in reducing the time spent in disturbed mood states.

Rapid cycling bipolar disorder post-heart transplant: A case report

Rapid cycling bipolar disorder post-heart transplant: A case report

Definition of Cycle and Episode in Rapid Cycling Bipolar Disorder: An Area of Debate in Diagnosis and Research

Definition of Cycle and Episode in Rapid Cycling Bipolar Disorder: An Area of Debate in Diagnosis and Research