Factors associated with rapid cycling in bipolar I manic patients: findings from a French national study.
BACKGROUND
Despite numerous explanatory hypotheses, few studies have involved a large national clinical sample examining risk factors in the occurrence of rapid cycling during the course of bipolar illness.


METHODS
From 1,090 manic bipolar I disorder inpatients included in a multicenter national study in France, 958 could be classified as rapid or nonrapid cyclers and assessed for demographic, illness course, clinical, psychometric, temperament, comorbidity, and treatment characteristics.


RESULTS
Rapid cycling bipolar disorder occurred in 9% (n=86) of the study group. Compared to nonrapid cyclers (n=872), patients with rapid cycling experienced the onset of their illness at a younger age, a higher number of prior episodes, more depression during the first episode, and more suicide attempts. At study entry, they also experienced manic episodes with more depressive and anxious symptoms, but less psychotic features. The following independent variables were associated with rapid cycling: longer duration of illness, antidepressant treatment, episodes with no free intervals, cyclothymic temperament, lower scores on the Scale for Assessment of Positive Symptoms and presence of thyroid disorder. Retrospective study limited to bipolar I disorder inpatients; several factors previously associated with rapid cycling were not assessed.


CONCLUSIONS
Our findings may confirm previous descriptions, according to which rapid cycling develops later in the course of illness following a sensitization process triggered by antidepressant use or thyroid dysfunction, in patients with a depression-mania-free interval course, and cyclothymic temperament.
University of Aix-Marseille II, and Department of Adult Psychiatry, Sainte Marguerite Hospital, Marseille Cedex 09, France. jazorin@ap-hm.fr
Jean-Michel
JM
Azorin
Arthur
A
Kaladjian
Marc
M
Adida
Elie G
EG
Hantouche
Ahcene
A
Hameg
Sylvie
S
Lancrenon
Hagop S
HS
Akiskal
D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003527:Cyclothymic Disorder / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D012307:Risk Factors; D013959:Thyroid Diseases / Q000150:complications
D000928:Antidepressive Agents