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Am J Psychiatry 1994; 151:506-515
Copyright © 1994 by American Psychiatric Association
Multisite data reanalysis of the validity of rapid cycling as a course modifier for bipolar disorder in DSM-IV
MS Bauer, J Calabrese, DL Dunner, R Post, PC Whybrow, L Gyulai, LK Tay, SR Younkin, D Bynum and P Lavori
Department of Psychiatry and Human Behavior, Brown University Program in Medicine, Providence, R.I.
OBJECTIVE: The validity of rapid cycling as a distinct course modifier for
bipolar disorder was assessed by comparing patients with and without a
history of rapid cycling (4 or more affective episodes in 12 months) on
demographic, clinical, family history, and outcome variables. These data
were also used to formulate operational criteria for the modifier. METHOD:
Data on subjects with rapid-cycling (N = 120) and nonrapid-cycling (N =
119) bipolar disorder from four sites were pooled and analyzed by using
case-control and historical cohort methods. RESULTS: The rapid-cycling
group contained more women and more subjects from higher social classes
than the nonrapid-cycling group. Family history did not differ between the
groups. The diagnosis had predictive validity in that the rapid-cycling
patients had more episodes than the nonrapid-cycling patients during
prospective follow- up. The relationship between gender and episode
frequency supported the validity of the cutoff point of 4-8 episodes per
year. The data regarding whether patients with rapid cycling based on
truncated episodes more closely resembled rapid-cycling or nonrapid-cycling
patients were equivocal. Patients whose only rapid cycling was associated
with antidepressants resembled spontaneously rapid-cycling patients, while
the majority of spontaneously rapid-cycling patients also had periods of
antidepressant-associated rapid cycling. CONCLUSIONS: The validity of rapid
cycling as a distinct course modifier for bipolar disorder is supported by
differences in gender, prospectively assessed outcome, and perhaps social
class between rapid- cycling and nonrapid-cycling patients. The
relationship of gender to episode frequency supports the cutoff of 4 or
more episodes per year.
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