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Empirical typology of bipolar I mood episodes

  • David A. Solomon (a1), Andrew C. Leon (a2), Jean Endicott (a3), William H. Coryell (a4), Chunshan Li (a2), Jess G. Fiedorowicz (a4) and Martin B. Keller (a5)...

Abstract

Background

Much remains unknown about the phenomenology of bipolar I disorder.

Aims

To determine the type of bipolar I mood episodes that occur over time, and their relative frequency.

Method

A total of 219 individuals with Research Diagnostic Criteria bipolar I disorder were prospectively followed for up to 25 years (median 20 years). Psychopathology was assessed with the Longitudinal Interval Follow-up Evaluation.

Results

Overall, 1208 mood episodes were prospectively observed. The episodes were empirically classified as follows: major depression, 30.9% (n = 373); minor depression, 13.0% (n = 157); mania, 20.4% (n = 246); hypomania, 10.4% (n = 126); cycling, 17.3% (n = 210); cycling plus mixed state, 7.8% (n = 94); and mixed, 0.2% (n = 2).

Conclusions

Cycling episodes constituted 25% of all episodes. Work groups revising ICD–10 and DSM–IV should add a category for bipolar I cycling episode.

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Copyright

Corresponding author

David A. Solomon, MD, Mood Disorders Program, Department of Psychiatry, Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island, 02903-4970, USA. Email: DASolomon@Lifespan.org

Footnotes

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Presented in part at the American Psychiatric Association, 161st Annual Meeting, Washington DC, 6 May 2008.

Funding for this study was provided by US National Institute of Mental Health grant MH25478-29.

Declaration of interest

D.A.S. has served as investigator for research funded by the US National Institute of Mental Health (NIMH), the US National Institute of Neurological Disorders and Stroke, Janssen Pharmaceutica, Wyeth-Ayerst Laboratories, and Merck; as consultant to Solvay Pharmaceuticals, Shire and Novartis; and on the lecture bureaux of AstraZeneca, Pfizer, GlaxoSmithKline, and Shire. A.C.L. has served as investigator for research funded by NIMH and the US National Institute of Drug Abuse, served on data safety monitoring boards for AstraZeneca, Dainippon Sumitomo Phrama (America), and Pfizer; and as consultant to the U.S. Food and Drug Administration, NIMH, Cyberonics, and MedAvante (equity). J.E. has been an investigator for research funded by four of the US National Institutes of Health and the New York State Department of Mental Health, received research support from Abbott, Bristol-Meyers Squibb, Cyberonics, Interneuron, Merck, Parke-Davis, Pfizer, Upjohn, and Wyeth-Ayerst, and served as consultant/advisory board member for Abbott, AstraZeneca, Berlex, Bristol-Meyers Squibb, Cyberonics, Eli Lilly, GlaxoSmithKline, Novartis, Otsuka, Janssen, Ovation, Pfizer, Sanofi-Synthelabo, and Wyeth-Ayerst. M.B.K. has served as consultant or received honoraria from Abbott, Cenerex, Cephalon, Cypress Bioscience, Cyberonics, Forest Laboratories, Janssen, JDS, Medtronic, Organon, Novartis, Pfizer, Roche, Solvay, and Wyeth Pharmaceuticals; received research support from Pfizer; and served on advisory boards for Abbott Laboratories, Bristol-Myers Squibb, Cenerex, Cyberonics, Cypress Bioscience, Forest Laboratories, Janssen, Novartis, Organon, and Pfizer.

Footnotes

References

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1 Craddock, N, Sklar, P. Genetics of bipolar disorder: successful start to a long journey. Trends Genet 2009; 25: 99105.
2 Katz, MM, Secunda, SK, Hirschfeld, RMA, Koslow, SH. NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression. Arch Gen Psychiatry 1979; 36: 765–71.
3 Spitzer, RL, Endicott, J, Robins, E. Research Diagnostic Criteria: rationale and reliability. Arch Gen Psychiatry 1978; 35: 773–82.
4 World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Version for 2007. WHO, 2006 (http://www.who.int/classifications/apps/icd/icd10online/gf30.htm).
5 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). APA, 1994.
6 Angst, J, Gamma, A, Sellaro, R, Lavori, PW, Zhang, H. Recurrence of bipolar disorders and major depression: a life-long perspective. Eur Arch Psychiatry Clin Neurosci 2003; 253: 236–40.
7 Sachs, GS, Thase, ME, Otto, MW, Bauer, M, Miklowitz, D, Wisniewski, SR, et al. Rationale, design, and methods of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Biol Psychiatry 2003; 53: 1028–42.
8 Nolen, WA, Luckenbaugh, DA, Altshuler, LL, Suppes, T, McElroy, SL, Frye, MA, et al. Correlates of 1-year prospective outcome in bipolar disorder: results from the Stanley Foundation Bipolar Network. Am J Psychiatry 2004; 161: 1447–54.
9 Solomon, DA, Leon, AC, Endicott, J, Coryell, WH, Mueller, TI, Posternak, MA, et al. Unipolar mania over the course of a 20-year follow-up study. Am J Psychiatry 2003; 160: 2049–51.
10 Endicott, J, Spitzer, RL. A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia. Arch Gen Psychiatry 1978; 35: 837–44.
11 Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, McDonald-Scott, P, et al. The longitudinal interval follow-up evaluation: a comprehensive method for assessing outcomes in prospective longitudinal studies. Arch Gen Psychiatry 1987; 44: 540–8.
12 Warshaw, MG, Keller, MB, Stout, RL. Reliability and validity of the Longitudinal Interval Follow-up Evaluation for assessing outcome of anxiety disorders. J Psychiatr Res 1994; 28: 531–45.
13 Keller, MB, Lavori, PW, Coryell, W, Andreasen, NC, Endicott, J, Clayton, PJ, et al. Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness. JAMA 1986; 255: 3138–42.
14 Maj, M, Pirozzi, R, Magliano, L, Bartoli, L. The prognostic significance of ‘switching’ in patients with bipolar disorder: a 10-year prospective follow-up study. Am J Psychiatry 2002; 159: 1711–7.
15 Angst, J. The course of affective disorders: II. Typology of bipolar manic-depressive illness. Arch Psychiat Nervenkr 1978; 226: 6573.
16 Keller, MB, Lavori, PW, Coryell, W, Endicott, J, Mueller, TI. Bipolar I: a five-year prospective follow-up. J Nerv Ment Dis 1993; 181: 238–45.
17 Turvey, CL, Coryell, WH, Solomon, DA, Leon, AC, Endicott, J, Keller, MB. Long-term prognosis of bipolar I disorder. Acta Psychiatr Scand 1999; 99: 110–9.
18 Kukopulos, A, Reginaldi, D, Laddomada, P, Floris, G, Serra, G, Tondo, L. Course of the manic-depressive cycle and changes caused by treatments. Pharmakopsychiatr Neuropsychopharmakol 1980; 13: 156–67.
19 Roy-Byrne, P, Post, RM, Uhde, TW, Porcu, T, Davis, D. The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH. Acta Psychiatr Scand 1985; 71 (suppl 317): 334.
20 Cole, AJ, Scott, J, Ferrier, IN, Eccleston, D. Patterns of treatment resistance in bipolar affective disorder. Acta Psychiatr Scand 1993; 88: 121–3.
21 Post, RM, Denicoff, KD, Leverich, GS, Altshuler, LL, Frye, MA, Suppes, TM, et al. Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH Life Chart Method. J Clin Psychiatry 2003; 64: 680–90.
22 Kraepelin, E. Manic-Depressive Insanity and Paranoia (trans Barclay, RM, ed Robertson, GM). E & S Livingstone, 1921.
23 Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J. The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976; 33: 766–71.
24 Koukopoulos, A, Sani, G, Koukopoulos, AE, Albert, MJ, Girardi, P, Tatarelli, R. Endogenous and exogenous cyclicity and temperament in bipolar disorder: review, new data and hypotheses. J Affect Disord 2006; 96: 165–75.
25 Martinez-Aran, A, Vieta, E, Chengappa, KNR, Gershon, S, Mullen, J, Paulsson, B. Reporting outcomes in clinical trials for bipolar disorder: a commentary and suggestions for change. Bipolar Disord 2008; 10: 566–79.
26 Solomon, DA, Leon, AC, Coryell, WH, Endicott, J, Li, C, Fiedorowicz, JG, et al. The longitudinal course of bipolar I mood episodes: duration of mood episodes. Arch Gen Psychiatry, in press.
27 Bunney, WE Jr, Goodwin, FK, Murphy, DL, House, KM, Gordon, EK. The ‘switch process’ in manic-depressive illness. II. Relationship to catecholamines, REM sleep, and drugs. Arch Gen Psychiatry 1972; 27: 304–9.
28 Suppes, T, Mintz, J, McElroy, SL, Altshuler, LL, Kupka, RW, Frye, MA, et al. Mixed hypomania in 908 patients with bipolar disorder evaluated prospectively in the Stanley Foundation Bipolar Treatment Network: a sex specific study. Arch Gen Psychiatry 2005; 62: 1089–96.
29 Judd, LL, Akiskal, HS, Schettler, PJ, Endicott, J, Maser, J, Solomon, DA, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002; 59: 530–7.
30 McElroy, SL, Keck, PE Jr, Pope, HG Jr, Hudson, JI, Faedda, GL, Swann, AC. Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania. Am J Psychiatry 1992; 149: 1633–44.
31 Bauer, MS, Simon, GE, Ludman, E, Unützer, J. ‘Bipolarity’ in bipolar disorder: distribution of manic and depressive symptoms in a treated population. Br J Psychiatry 2005; 187: 87–8.
32 Ghaemi, SN. All mixed up: on the absence of diagnostic guidelines for mixed states in the ISBD Diagnostic Guidelines Task Force Report. Bipolar Disord 2008; 10: 129–30.
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Empirical typology of bipolar I mood episodes

  • David A. Solomon (a1), Andrew C. Leon (a2), Jean Endicott (a3), William H. Coryell (a4), Chunshan Li (a2), Jess G. Fiedorowicz (a4) and Martin B. Keller (a5)...
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