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International Journal of Bipolar Disorders

Table 2 Factors associated with rapid cycling in bipolar disorder patients

From: Characteristics of rapid cycling in 1261 bipolar disorder patients

Factor

Measure or proportion [with 95% CI]

χ2 or

t-score

p-value

RC

nonRC

RR

 Subjects (n)

118

1143

1/9.69

–––

–––

RC > nonRC

 Switch with antidepressant (%)

77.5 [68.1–85.1]

35.5 [33.1–38.0]

2.18

70.9

 < 0.0001

 Inferior treatment response (%)

51.8 [38.0–65.3]

16.1 [13.0–19.7]

3.22

40.5

 < 0.0001

 Predominant depression

85.0 [76.9–91.2]

58.6 [55.6–61.3]

1.45

28.6

 < 0.0001

 Total years ill

23.0 [20.5–25.4]

17.5 [16.7–18.3]

1.31

4.04

 < 0.0001

 Children/person

1.38 [1.09–1.68]

0.90 [0.82–0.98]

1.11

3.49

0.0005

 Mood-stabilizer use

84.0 [63.9–95.5]

49.8 [43.5–56.1]

1.69

10.7

0.001

 Age at intake

45.0 [41.5–48.5]

39.4 [38.2–40.5]

1.14

3.06

0.002

 Ever married (%)

58.8 [49.1–67.9]

44.0 [40.0–47.0]

1.34

9.09

0.003

 Siblings/person

4.40 [3.85–4.95]

3.68 [3.53–3.82]

1.20

2.99

0.003

 Initial depression (%)

76.2 [67.7–83.5]

63.2 [61.0–65.5]

1.21

8.37

0.004

 Follow-up (years)

11.5 [9.25–13.7]

8.81 [8.14–9.48]

1.30

2.51

0.01

 Suicidal acts (%)

25.2 [17.7–34.0]

16.7 [15.0–18.5]

1.51

5.72

0.02

 Medical comorbidity (%)

73.4 [60.9–83.7]

59.0 [54.9–63.1]

1.24

5.00

0.03

 Intake depression (HDRS)

18.5 [13.1–23.8]

12.5 [10.8–14.2]

1.48

2.23

0.03

 Cyclothymic temperament

6.78 [5.65–7.92]

5.48 [5.11–5.85]

1.24

2.16

0.03

 Early sexual abuse (%)

28.6 [14.6–46.3]

15.6 [18.8–20.0]

1.83

3.80

0.05

nonRC > RC

 Antidepressant use (%)

51.9 [48.5–55.3]

58.5 [56.9–60.0]

1/1.13

12.4

0.0004

 Initial [hypo] mania or psychosis (%)

8.20 [4.00–14.6]

18.4 [16.6–20.2]

1/2.24

8.12

0.004

 Drug abuse (%)

11.7 [6.39–19.2]

23.0 [23.5–25.7]

1/1.97

7.51

0.006

 Cigarettes/day

7.32 [4.80–9.85]

10.8 [9.79–11.8]

1/1.48

2.14

0.03

  1. RR = rate ratio for RC/nonRC. Prospective assessments of morbidity are shown in Table 3. Factors that did not differ significantly between RC and nonRC subjects included: family history (any psychiatric disorder, mood disorders, BD or suicide, and % of relatives with any disorder), early physical abuse, years of education, unemployment, socioeconomic status, separation or divorce, decade of birth, age at first symptoms, syndromal onset, or treatment), first episode mixed manic-depressive, intake ratings of anxiety (HARS) or functional status (GAF), non-cyclothymic affective temperament ratings, course-type (MDI vs. DMI), alcohol abuse, caffeine consumption, obesity (BMI), metabolic syndrome, serum level of TSH, T3 and T4 thyroid hormones, co-occurring anxiety or attention disorders, seasonal mood-shifts, and hospitalizations/year
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