The Phenomenon of Rapid Cycling in Bipolar Mood Disorders: A Review

Persad, Emmanuel; Oluboka, O. J.; Sharma, Verinder; Mazmanian, Dwight; Kueneman, Karen

doi:10.1177/070674379604100107

Cited by 12 publications

(8 citation statements)

References 44 publications

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“…This review summarizes what is known about treatment responses in patients with RC bipolar disorder based on available results of long‐term therapeutic trials. The main findings include: (a) an estimated risk of 15.4% for RC in samples apparently not selected for such cases accords with other reports (2, 4, 10, 11, 15, 16, 24, 42); (b) RC patients consistently showed less favorable treatment responses than non‐RC subjects across all treatments studied; (c) quantitative direct comparisons between active treatments could be made only for lithium vs. carbamazepine and indicated similar outcomes.…”

Section: Discussionsupporting

confidence: 83%

“…That is, rates of improvement were more than twice as probable (49.6%/24.0%) as rates of non‐recurrence among RC patients, and 1.78‐times (64.8%/36.5%) more frequent among non‐RC subjects. Indeed, total long‐term protection from recurrences is a clinically unrealistic expectation in a disorder characterized by episodic recurrences, and particularly among RC patients, whose illnesses may be unusually complex and difficult to treat (6, 10–15). In our opinion, improvement in symptomatic and functional status during treatment may be more clinically pertinent measures of realistic treatment responses, particularly among RC bipolar disorder patients (36, 42, 49, 50).…”

Section: Discussionmentioning

confidence: 99%

“…The phenomenon and aspects of its treatment have been reviewed recently (3–6). Several authors have hypothesized that RC in bipolar disorder, in addition to being associated with greater morbidity in the absence of treatment, may also predict an inferior response to lithium maintenance therapy, possibly with superior responses to some anticonvulsants (7–12). Based on the very strict criterion of virtually complete protection from recurrences, response rates with lithium have averaged <30% among RC patients in several studies (10–13).…”

Section: Introductionmentioning

confidence: 99%

“…Several authors have hypothesized that RC in bipolar disorder, in addition to being associated with greater morbidity in the absence of treatment, may also predict an inferior response to lithium maintenance therapy, possibly with superior responses to some anticonvulsants (7–12). Based on the very strict criterion of virtually complete protection from recurrences, response rates with lithium have averaged <30% among RC patients in several studies (10–13). There have been repeated suggestions that treatment with some anticonvulsants might yield more favorable responses than lithium among RC patients (12–17).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Rapid‐cycling bipolar disorder: effects of long‐term treatments

Tondo

Hennen

2003

Acta Psychiatr Scand

111

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Rapid‐cycling bipolar disorder: effects of long‐term treatments

Tondo

Hennen

2003

Acta Psychiatr Scand

111

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“…53 É comum que o tratamento antidepressivo desses pacientes resulte em ciclagem para a mania, 54 e que talvez este possa contribuir para tornar esses pacientes cicladores rápidos, refratários ao tratamento. 55 Portanto, o desenvolvimento futuro de novas estratégias para este grupo particular de pacientes será muito relevante.…”

Section: Perspectivas Para O Tratamentounclassified

Transtornos afetivos: pesquisa e perspectivas para o futuro

Soares

1999

Rev. Bras. Psiquiatr.

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ResumoNeste breve comentário, áreas particularmente promissoras de pesquisa básica e clínica que visam elucidar a etiologia e fisiopatologia dos transtornos afetivos são sumarizadas. Perspectivas para pesquisa e desenvolvimento futuro são brevemente discutidas, com ênfase particular em possibilidades para o desenvolvimento de novas intervenções terapêuticas para esses transtornos. DescritoresTranstornos afetivos; depressão; etiologia; fisiopatologia; tratamento AbstractImportant new areas of basic and clinical research that attempt to elucidate the etiology and pathophysiology of mood disorders are briefly summarized. Particular emphasis is given to research that may contribute to the development of new therapeutic interventions for these disorders. Perspectives for development in these areas are briefly discussed, and future directions are suggested. KeywordsMood disorders; depression; etiology; pathophysiology; treatment IntroduçãoTranstornos afetivos, unipolares e bipolares, são muito prevalentes na comunidade geral e na prática clínica, e causam sofrimento humano importante, assim como perda econômica substancial para a sociedade.1-4 Apesar de numerosas investigações ao longo das últimas décadas, a etiologia e fisiopatologia desses distúrbios ainda são, em sua maior parte, desconhecidas. Recentemente, atrelados a avanços consideráveis nas neurociências, um número cada vez maior de estudos básicos e clínicos tem se dedicado a tentar esclarecer a fisiopatologia desses distúrbios. Neste breve comentário, áreas de pesquisa particularmente promissoras em relação aos transtornos afetivos serão discutidas. Perspectivas para esclarecimento da fisiopatologiaRelatos recentes sugerem alterações anatômicas discretas, assim como alterações funcionais e neuroquímicas no cérebro de pacientes com transtornos afetivos.5-11 Desenvolvimentos apreciáveis nas metodologias de tomografia computadorizada por emissão de fóton único (Spect), tomografia por emissão de pósitron (PET), e ressonância nuclear magnética (MRI), tanto funcional (fMRI), quanto por espectroscopia (MRS), tem ocorrido nos últimos anos. Já a anatomia, assim como processos fisiológicos e neuroquímicos do cérebro de pacientes vivos começam a ficar acessíveis ao estudo direto.12-14 Entre as alterações anatômicas identificadas, há relatos de anomalias em córtex pré-frontal, gânglios da base, cerebelo, e estruturas mediais do lobo temporal.5,9,* Alterações funcionais, refletidas em alterações de fluxo sangüíneo e metabolismo de glicose cerebrais, têm também sido encontradas em várias dessas mesmas regiões cerebrais. 6,7,15 Estudos preliminares in vivo de receptores cerebrais sugerem alterações nos sistemas serotonérgico e dopaminérgico.11,16,* Investigações com 31P e 1H MRS sugerem alterações em processos de membrana e metabolismo neuronais. 17,18 Em conclusão, essas novas áreas de pesquisa têm um potencial enorme para resultar na elucidação dos mecanismos cerebrais envolvidos nesses distúrbios. Tais mecanismos, se identificados, podem propiciar alvos específicos para...

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Sleep and sleep-wake cycle in an 81-year-old patient with de novo ultra-rapid cycling bipolar disorder

Schreiner

Mirisch

Veselý

et al. 2001

European Archives of Psychiatry and Clinical Neuroscience

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This is a case report of an 81-year-old man who developed de novo bipolar disorder with ultrarapid cycling at the age of 80. Mood was self-rated daily over a period of ten weeks; in addition, polysomnographic and motor activity recordings were performed during a drug-free baseline period. Both depressive and hypomanic episodes had an average duration of about 30 hours; the affective cycle was thus independent from the sleep-wake cycle. When mood shifts occurred during nighttime, sleep was different in nights following depression than in nights following hypomania. Positron emission tomography revealed a moderate bilateral frontal hypermetabolism in the hypomanic phase and yielded normal findings for the depressive stage. In contrast to what is usually expected in ultra-rapid cycling bipolar disorder, this case demonstrates an unusual sleep-unrelated cycle duration in the oldest reported patient so far.

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The Phenomenon of Rapid Cycling in Bipolar Mood Disorders: A Review

Abstract: Caution should be exercised in the use of antidepressants in patients with bipolar mood disorders.

Cited by 12 publications

References 44 publications

Rapid‐cycling bipolar disorder: effects of long‐term treatments

Rapid‐cycling bipolar disorder: effects of long‐term treatments

Transtornos afetivos: pesquisa e perspectivas para o futuro

Sleep and sleep-wake cycle in an 81-year-old patient with de novo ultra-rapid cycling bipolar disorder

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