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The Spectrum of Rapid Cycling

Published online by Cambridge University Press:  07 November 2014

Trisha Suppes
Trisha Suppes*
Affiliation:
Dr. Suppes is associate professor of psychiatry in the Department of Psychiatry and director of the Bipolar Disorders Clinic and Research Program at UT Southwestern Medical Center in Dallas, Texas.
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Extract

While rapid cycling was first identified by Dunner and Fieve in 1974, there is quite a good historical background on the concept. In the 1800s Falret and colleagues identified what they called a “circular course distinct from alternating.” What they meant by “alternating” was a period of remission following an episode. Currently, all types and ranges of cycling are lumped under one rubric; the spectrum ranges from having >4 cycling episodes, the minimum required for rapid cycling, through ultradian cycling, which is far more severe.

While some patients manifest chronic depression with periodic hypermania, which is known as bipolar II, others have ultradian cycles, which are often seen as pure affective instability. We do not know whether these types represent different stages of a disorder that exists on a spectrum or whether they are actually distinct categories of the disorder: one being patients who experience mania, depression, and then remission; the second being those with more continuous cycling that includes ultradian cycling. Greater understanding of the biological underpinnings of the illness will help to determine whether these conditions exist on a spectrum.

Rapid cycling may become less prevalent with age. In the Depression Collaborative Study, Coryell and colleagues found a diminishment of rapid cycling over the course of 13 years. Studies from the Stanley Bipolar Foundation group suggest that the cycling may accelerate in some, but not others. Over a long observation period in ~100 patients, Koukopoulos and colleagues found that once a pattern of rapid cycling is established in a patient, this pattern may become a hallmark of their illness.

Type
Research Article
Information
CNS Spectrums , Volume 9 , Issue S2 , 2004 , pp. 7 - 8
Copyright
Copyright © Cambridge University Press 2004

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