Bauer M S, Calabrese J, Dunner D L, Post R, Whybrow P C, Gyulai L, Tay L K, Younkin S R, Bynum D, Lavori P
Department of Psychiatry and Human Behavior, Brown University Program in Medicine, Providence, R.I.
Am J Psychiatry. 1994 Apr;151(4):506-15. doi: 10.1176/ajp.151.4.506.
The validity of rapid cycling as a distinct course modifier for bipolar disorder was assessed by comparing patients with and without a history of rapid cycling (4 or more affective episodes in 12 months) on demographic, clinical, family history, and outcome variables. These data were also used to formulate operational criteria for the modifier.
Data on subjects with rapid-cycling (N = 120) and nonrapid-cycling (N = 119) bipolar disorder from four sites were pooled and analyzed by using case-control and historical cohort methods.
The rapid-cycling group contained more women and more subjects from higher social classes than the nonrapid-cycling group. Family history did not differ between the groups. The diagnosis had predictive validity in that the rapid-cycling patients had more episodes than the nonrapid-cycling patients during prospective follow-up. The relationship between gender and episode frequency supported the validity of the cutoff point of 4-8 episodes per year. The data regarding whether patients with rapid cycling based on truncated episodes more closely resembled rapid-cycling or nonrapid-cycling patients were equivocal. Patients whose only rapid cycling was associated with antidepressants resembled spontaneously rapid-cycling patients, while the majority of spontaneously rapid-cycling patients also had periods of antidepressant-associated rapid cycling.
The validity of rapid cycling as a distinct course modifier for bipolar disorder is supported by differences in gender, prospectively assessed outcome, and perhaps social class between rapid-cycling and nonrapid-cycling patients. The relationship of gender to episode frequency supports the cutoff of 4 or more episodes per year.
通过比较有和没有快速循环病史（12个月内有4次或更多情感发作）的双相情感障碍患者在人口统计学、临床、家族史和结局变量方面的情况，评估快速循环作为双相情感障碍一种独特病程修饰因素的有效性。这些数据还用于制定该修饰因素的操作标准。
汇总来自四个研究地点的快速循环型（N = 120）和非快速循环型（N = 119）双相情感障碍患者的数据，并采用病例对照和历史队列方法进行分析。
与非快速循环组相比，快速循环组女性更多，来自较高社会阶层的受试者更多。两组之间家族史无差异。该诊断具有预测效度，因为在前瞻性随访期间，快速循环型患者比非快速循环型患者发作次数更多。性别与发作频率之间的关系支持每年4 - 8次发作这一截断点的有效性。关于基于截断发作的快速循环型患者与快速循环型或非快速循环型患者更相似的数据并不明确。仅因使用抗抑郁药而出现快速循环的患者与自发快速循环型患者相似，而大多数自发快速循环型患者也有与抗抑郁药相关的快速循环期。
快速循环型和非快速循环型患者在性别、前瞻性评估的结局以及可能的社会阶层方面存在差异，这支持了快速循环作为双相情感障碍一种独特病程修饰因素的有效性。性别与发作频率的关系支持每年4次或更多次发作的截断标准。
