Conference paper
BIPOLAR DISORDER: THE IMPORTANCE OF CLINICAL ASSESSMENT IN IDENTIFYING PROGNOSTIC FACTORS - AN AUDIT. Part 2: Mixed state features and rapid cycling
Norma Verdolini
; School of Specialization in Psychiatry, Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
Jonathon Dean
; School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital Gonville and Caius College, Cambridge, UK
Sandro Elisei
; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
Roberto Quartesan
; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
Rashid Zaman
; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy ; South Essex Partnership University Foundation Trust, Bedfordshire Centre for Mental Health Research in association with the University of Cambridge, Department of Psychiatry, University of Cambridge, UK
Mark Agius
; South Essex Partnership University Foundation Trust, Bedfordshire Centre for Mental Health Research in association with the University of Cambridge, Department of Psychiatry, University of Cambridge, UK ; Clare College Cambridge, The University of Cambridge, Cambridge, UK
Abstract
Background: Rapid cycling in bipolar disorder complicates the clinical picture and worsens the long-term outcomes of bipolar
disorder. Mixed states features do similarly and are known to present an increased risk to patients. Early recognition of these
patterns can lead to better treatment strategies and improvement of the long-term course of the disease.
Method: We collected data from the clinical notes of 70 bipolar outpatients seen at an ASPA (initial assessment) clinic about
socio-demographic and clinical characteristics.
Results: The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; percentages reported in our results
are of the sample for which the data was available. 71.7 % (33 patients) of the sample reported mixed states features and 32 patients
(72.7%) are recorded to have more than 4 changes in mood in a year. There were no statistically significant correlations between
mixed state features or rapid cycling and anhedonia, suicidal ideation, borderline symptoms, OCD symptoms, anxiety, positive
psychiatric family history, current alcohol use, previous alcohol use, current illicit drug use, or previous illicit drug use. An almost
significant correlation was found between mixed state features and anxiety. Assignation of a care coordinator did not seem to be
associated with these prognostic factors.
Conclusions: The two subgroups of mixed state features and rapid cycling patients share very common clinical characteristics:
high incidence of suicidal thoughts, high levels of anxiety, and high previous substance use – but low levels of current alcohol and
drug use and high levels of features of atypical depression. These features of mixed state bipolar disorder and rapid cycling bipolar
disorder should be identified during psychiatric assessment to identify useful information for prognosis.
Keywords
bipolar affective disorder; comorbidity; mixed affective states; rapid cycling
Hrčak ID:
265734
URI
Publication date:
5.11.2014.
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