Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
Abarbanel Mental Health Center, Bat Yam, Israel.
Bipolar Disord. 2021 Jun;23(4):391-399. doi: 10.1111/bdi.12994. Epub 2020 Oct 8.
The "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a major depressive episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as rapid cycling (RC).
Psychiatric symptoms, socio-demographic, and clinical variables were collected from a sample of 2811 MDE patients, of which 726 (25.8%) were diagnosed with bipolar disorder (BD). The characteristics of bipolar patients with RC (BD-RC) and without (BD-NRC) RC were compared.
Of 726 BD patients, 159 (21.9%) met DSM-5 criteria for RC. BD-RC group presented a higher number of lifetime depressive episodes (p < 0.001) with shorter duration of depressive episodes, and more psychiatric comorbidities, as well as higher rates of atypical features (p = 0.016) and concomitant (hypo)manic symptoms (irritable mood (p = 0.001); risky behavior (p = 0.005); impulsivity (p = 0.006); and psychomotor agitation (p = 0.029)). Patients with RC had a worse functioning (p = 0.033), more obesity (p = 0.003), and were significantly more likely to be treated with three or more drugs (p = 0.007).
Important clinical differences between bipolar patients with and without a RC include more depressive morbidity, higher incidence of anxiety disorders, addiction, bulimia, and borderline personality disorder, as well as atypical features during depression and symptoms such as irritability, risky behavior, impulsivity, and agitation. RC patients had poorer functioning than patients without RC, more obesity, and had to be treated with more drugs.
“双相情感障碍：提高诊断、指导和教育”（BRIDGE-II-Mix）研究旨在根据不同的定义估计单相抑郁发作（MDE）患者中混合状态的频率，并比较其临床有效性，研究特定特征，如快速循环（RC）。
从 2811 例 MDE 患者中收集了精神症状、社会人口学和临床变量，其中 726 例（25.8%）被诊断为双相障碍（BD）。比较了有 RC（BD-RC）和无 RC（BD-NRC）的双相患者的特征。
726 例 BD 患者中，159 例（21.9%）符合 DSM-5 关于 RC 的标准。BD-RC 组有更多的终生抑郁发作次数（p<0.001），抑郁发作持续时间更短，以及更多的精神共病，以及更高的非典型特征（p=0.016）和伴随（轻躁狂）症状发生率（烦躁情绪（p=0.001）；冒险行为（p=0.005）；冲动性（p=0.006）；和精神运动激越（p=0.029））。RC 患者的功能更差（p=0.033），肥胖（p=0.003）的发生率更高，并且更有可能接受三种或更多药物治疗（p=0.007）。
RC 阳性和 RC 阴性的双相患者之间存在重要的临床差异，包括更多的抑郁发病、焦虑障碍、成瘾、贪食症和边缘型人格障碍的发生率更高，以及抑郁期的非典型特征，如烦躁、冒险行为、冲动和激越。RC 患者的功能比 RC 阴性患者差，肥胖的发生率更高，需要使用更多的药物治疗。
