title: Rapid-cycling bipolar I disorder: course and treatment outcome of a large sample across Europe.
abstract: OBJECTIVE
  To evaluate the baseline characteristics and follow-up outcomes of rapid-cycling (RC) bipolar I patients in a large, prospective, observational study.
  
  
  METHODS
  EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) is a long-term prospective observational study of in- and outpatients with an acute mania/mixed episode conducted in 14 European countries. Demographic and clinical variables were collected at baseline, including the presence or absence of DSM-IV rapid-cycling during the past year. Outcome measures included the 5-item Hamilton Depression Rating Scale (HAMD-5) and Young Mania Rating Scale (YMRS) over 12 weeks, as well as the Clinical Global Impressions-Bipolar Disorder Scale (CGI-BP overall, mania and depression) over 12 months.
  
  
  RESULTS
  Of 3684 patients enrolled, 3089 patients provided reliable data to qualify for either RC (N=535, 17.3%) or non-RC (NRC, N=2554), according to DSM-IV. RC prevalence varied across countries (p<0.001). Baseline and 12 week outcomes on the YMRS and HAMD-5, 12 month ratings on the CGI-BP subscales and work impairment at 12 months were significantly different (p<0.001) between groups, being worse in RC. RC patients were more likely to receive antidepressants and lamotrigine (p<0.001). Using logistic regression, RC was associated to country (p<0.001), female sex (p=0.029), outpatients (p=0.035), more history of attempted suicide (p<0.001) and alcohol abuse (p<0.001).
  
  
  CONCLUSIONS
  The EMBLEM results suggest that in naturalistic settings, patients with mania and RC differ from NRC in socio-demographic characteristics, treatment prescriptions and clinical outcome measures with a consistently worse occupational outcome and comorbidities. RC represents a longitudinally severe form of bipolar disorder, with poorly evidence-based diagnostic and therapeutic tools.
authors.affiliation: Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Cruz
authors.forename: E
authors.initials: E
authors.lastname: Vieta
authors.forename: M
authors.initials: M
authors.lastname: Comes
authors.forename: J M
authors.initials: JM
authors.lastname: Haro
authors.forename: C
authors.initials: C
authors.lastname: Reed
authors.forename: J
authors.initials: J
authors.lastname: Bertsch
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000145:classification / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019370:Observation; D017063:Outcome Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D014227:Triazines / Q000627:therapeutic use*
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D014227:Triazines; D000077213:Lamotrigine