Rapid cycling in bipolar disorder linked to serious life disruption
MedWire News: Patients with bipolar disorder who experience frequent mood episodes show a greater level of life disruption than their peers with less frequent episodes, results of a large community study show.
The investigators also found that only about half of those with recent bipolar disorder report treatment for depression or mania/hypomania.
“It seems that efforts to encourage access to treatment and maintenance of treatment could do much to ameliorate the course of disorder,” say J Elisabeth Wells (University of Otago, Christchurch, New Zealand) and colleagues in the Journal of Affective Disorders.
A number of cross-sectional epidemiological studies have examined the prevalence of bipolar disorder – with estimates ranging from 0.5% for euphoric-grandiose bipolar I disorder to 5.5% for generally defined bipolar disorder.
However, most such studies have not collected information on the frequency of mood episodes, and it remains unclear to what extent disability results from rapid cycling or from the severity of mood episodes regardless of frequency.
The New Zealand Mental Health Survey is a national cross-sectional survey with a multi-stage probability sample of individuals aged 16 years or more living in the community.
From a total sample size of 12,992, the lifetime prevalence of broadly defined bipolar disorder was 3.8% – with a prevalence of 1.0% for bipolar I disorder and 0.7% for bipolar II disorder.
When lifetime bipolar disorder cases were grouped by mood episode frequency in the past 12 months, the prevalence was 0.3% with frequent mood episodes (FME), 0.7% with 1–3 episodes (no FME), and 0.7% with no episodes.
Patients with 12-month FME had earlier onset of bipolar disorder than 12-month cases without FME or those with lifetime bipolar disorder but with no episode in the past 12 months ((16.0 vs 19.5 and 20.1 years, respectively).
The number of weeks in episode, total days out of role, and role impairment in were all worse for the FME group. Both the FME and no-FME groups experienced severe and impairing depression, and lifetime suicidal behaviors and comorbidity were high in all three bipolar groups with little difference between them.
“In summary, these results indicate that predictors and correlates are similar in those with and without FME but that the burden of bipolar disorder is more for those with frequent episodes,” Wells and colleagues conclude.
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By Andrew Czyzewski