title: Rapid switching of mood in families with multiple cases of bipolar disorder.
abstract: BACKGROUND
  Heterogeneity within the diagnostic construct of bipolar disorder is most likely an obstacle to discovering its causes. Phenomena in the bipolar spectrum, including rapid cycling, cyclothymia, and affective instability of borderline personality, may be important markers of etiologic heterogeneity. Rapid switching of mood may be central to these phenomena.
  
  
  METHODS
  We performed a case-control study, using diagnostic data from a multisite bipolar disorder linkage study, to explore clinical and demographic factors potentially related to rapid switching in bipolar disorder. Participants were 18 years or older and members of a family in which 2 or more first-degree relatives had bipolar disorder. Of 718 individuals interviewed and diagnosed as having bipolar disorder, 603 gave sufficient information about rapid switching and thus constituted the study group (60% female; mean age, 41 years; and mean education level, 13.8 years).
  
  
  RESULTS
  Rapid switching of mood was reported by 44% of interviewees and was associated with early age at onset of bipolar disorder, higher risk of anxiety and substance abuse or dependence comorbidity, suicide attempts, antidepressant drug use, and having a relative with rapid switching.
  
  
  CONCLUSIONS
  Rapid switching is associated with a complex clinical course of bipolar disorder. These results extend previous associations among rapid switching, anxiety, substance abuse, and early onset of bipolar disorder to a family study population. Rapid switching of mood seems to be the core phenomenon behind several variants of non-DSM-IV rapid cycling, DSM-III-R mixed states, and borderline personality disorder and the link connecting comorbidity, suicide, and early onset of bipolar disorder. Further biological investigation of the rapid-switching phenomenon is justified on epidemiologic grounds.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. dmackin@jhmi.edu
authors.forename: Dean F
authors.initials: DF
authors.lastname: MacKinnon
authors.forename: Peter P
authors.initials: PP
authors.lastname: Zandi
authors.forename: Elliot
authors.initials: E
authors.lastname: Gershon
authors.forename: John I
authors.initials: JI
authors.lastname: Nurnberger
authors.forename: Theodore
authors.initials: T
authors.lastname: Reich
authors.forename: J Raymond
authors.initials: JR
authors.lastname: DePaulo
mesh_terms: D000328:Adult; D000339:Affect; D017668:Age of Onset; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D016022:Case-Control Studies; D015897:Comorbidity; D005190:Family; D005192:Family Health; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data