title: Bipolar disorder: The importance of clinical assessment in identifying prognostic factors - An Audit. Part 2: Mixed state features and rapid cycling.
abstract: BACKGROUND
  Rapid cycling in bipolar disorder complicates the clinical picture and worsens the long-term outcomes of bipolar disorder. Mixed states features do similarly and are known to present an increased risk to patients. Early recognition of these patterns can lead to better treatment strategies and improvement of the long-term course of the disease.
  
  
  METHODS
  We collected data from the clinical notes of 70 bipolar outpatients seen at an ASPA (initial assessment) clinic about socio-demographic and clinical characteristics.
  
  
  RESULTS
  The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; percentages reported in our results are of the sample for which the data was available. 71.7% (33 patients) of the sample reported mixed states features and 32 patients (72.7%) are recorded to have more than 4 changes in mood in a year. There were no statistically significant correlations between mixed state features or rapid cycling and anhedonia, suicidal ideation, borderline symptoms, OCD symptoms, anxiety, positive psychiatric family history, current alcohol use, previous alcohol use, current illicit drug use, or previous illicit drug use. An almost significant correlation was found between mixed state features and anxiety. Assignation of a care coordinator did not seem to be associated with these prognostic factors.
  
  
  CONCLUSIONS
  The two subgroups of mixed state features and rapid cycling patients share very common clinical characteristics: high incidence of suicidal thoughts, high levels of anxiety, and high previous substance use - but low levels of current alcohol and drug use and high levels of features of atypical depression. These features of mixed state bipolar disorder and rapid cycling bipolar disorder should be identified during psychiatric assessment to identify useful information for prognosis.
authors.affiliation: School of Specialization in Psychiatry, Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy, norma.verdolini@libero.it.
authors.forename: Norma
authors.initials: N
authors.lastname: Verdolini
authors.forename: Jonathon
authors.initials: J
authors.lastname: Dean
authors.forename: Sandro
authors.initials: S
authors.lastname: Elisei
authors.forename: Roberto
authors.initials: R
authors.lastname: Quartesan
authors.forename: Rashid
authors.initials: R
authors.lastname: Zaman
authors.forename: Mark
authors.initials: M
authors.lastname: Agius