David Baxter PhD
Late Founder
Rapid switching bipolar disorder has complex clinical course
By Cher Thornhill
21 July 2008
Bipolar Disord 2008; 10: 597-606
Bipolar disorder patients who experience rapid mood switching have a complex clinical course, characterized by earlier onset and high rates of comorbid anxiety and sensitivity to antidepressants, researchers confirm.
"These results support a clinical differentiation of bipolar disorder into subtypes based on symptom stability," says the team, led by Evaristus Nwulia (Howard University Hospital, Washington, DC, USA).
The participants included 1143 probands diagnosed with bipolar I (BPI) affective disorder from 10 centers across the USA and their relatives with bipolar disorder. All of the probands selected for the study had at least one sibling with BPI or schizoaffective disorder, bipolar type (SABP).
The participants were interviewed using the Diagnostic Interview for Genetic Studies (DIGS) - which has excellent test-retest reliability for diagnosing affective disorders - and were each asked: "Have you ever switched back and forth quickly between feeling high and feeling normal or depressed?"
Individuals with rapid mood switching were diagnosed with bipolar disorder when they were significantly younger (18 vs 21 years) than those without rapid switching, the researchers report.
These patients had higher rates of psychiatric comorbidities than those without rapid switching, including anxiety (47% vs 26%), substance abuse disorders (52% vs 42%), obsessive compulsive disorder (11% vs 3%), and childhood hyperactivity/learning disorder (36% vs 18%).
Rapid switchers also showed significantly higher rates of violent (6% vs 3%) and suicidal (46% vs 31%) behavior, and non-suicidal self-harm (13% vs 6%) than the other patients, the team reports in the journal Bipolar Disorders.
After adjusting for potentially confounding factors, the researchers found that the early emergence of symptoms, comorbid anxiety and hypersensitivity to antidepressants remained strongly associated with rapid switching.
The findings agree with a previous study, which the researchers say "robustly associated" rapid mood switching with early age of disease onset, comorbid anxiety, suicide attempts, and antidepressant-induced activation.
"The idea that some individuals with bipolar disorder experience greater flux than others in their episode frequency and rate of switching is not so much new as it is a potential refinement of concepts variously described in the DSM and the literature as mixed states, ultra-rapid cycling, and affective lability," write Nwulia et al.
"The implications of this hypothesis for the understanding of disease etiology remain to be seen."
Abstract
By Cher Thornhill
21 July 2008
Bipolar Disord 2008; 10: 597-606
Bipolar disorder patients who experience rapid mood switching have a complex clinical course, characterized by earlier onset and high rates of comorbid anxiety and sensitivity to antidepressants, researchers confirm.
"These results support a clinical differentiation of bipolar disorder into subtypes based on symptom stability," says the team, led by Evaristus Nwulia (Howard University Hospital, Washington, DC, USA).
The participants included 1143 probands diagnosed with bipolar I (BPI) affective disorder from 10 centers across the USA and their relatives with bipolar disorder. All of the probands selected for the study had at least one sibling with BPI or schizoaffective disorder, bipolar type (SABP).
The participants were interviewed using the Diagnostic Interview for Genetic Studies (DIGS) - which has excellent test-retest reliability for diagnosing affective disorders - and were each asked: "Have you ever switched back and forth quickly between feeling high and feeling normal or depressed?"
Individuals with rapid mood switching were diagnosed with bipolar disorder when they were significantly younger (18 vs 21 years) than those without rapid switching, the researchers report.
These patients had higher rates of psychiatric comorbidities than those without rapid switching, including anxiety (47% vs 26%), substance abuse disorders (52% vs 42%), obsessive compulsive disorder (11% vs 3%), and childhood hyperactivity/learning disorder (36% vs 18%).
Rapid switchers also showed significantly higher rates of violent (6% vs 3%) and suicidal (46% vs 31%) behavior, and non-suicidal self-harm (13% vs 6%) than the other patients, the team reports in the journal Bipolar Disorders.
After adjusting for potentially confounding factors, the researchers found that the early emergence of symptoms, comorbid anxiety and hypersensitivity to antidepressants remained strongly associated with rapid switching.
The findings agree with a previous study, which the researchers say "robustly associated" rapid mood switching with early age of disease onset, comorbid anxiety, suicide attempts, and antidepressant-induced activation.
"The idea that some individuals with bipolar disorder experience greater flux than others in their episode frequency and rate of switching is not so much new as it is a potential refinement of concepts variously described in the DSM and the literature as mixed states, ultra-rapid cycling, and affective lability," write Nwulia et al.
"The implications of this hypothesis for the understanding of disease etiology remain to be seen."
Abstract
