Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-05T16:04:23.210Z Has data issue: false hasContentIssue false

12 - Comorbidity in mixed states and rapid-cycling forms of bipolar disorders

Published online by Cambridge University Press:  10 August 2009

Peter Brieger
Affiliation:
Martin-Luther-University Halle-Wittenberg Halle Germany
Andreas Marneros
Affiliation:
Martin Luther-Universität Halle-Wittenburg, Germany
Frederick Goodwin
Affiliation:
George Washington University, Washington DC
Get access

Summary

Relevance of comorbidity

In recent years, much has been written on the comorbidity of bipolar disorders with other mental illnesses. Several studies have reported distinct patterns showing how bipolar disorders and other mental disorders co-occur (Brieger, 2000; McElroy et al., 2001). Generally, in patients with bipolar disorders, there is an unexpected excess of co-occurring anxiety disorders and substance-abuse disorders. Concerning personality disorders, there is some evidence that patients with bipolar disorders show higher rates than the normal population, but lower rates than patients with unipolar affective disorders (Brieger et al., 2003a). Such results are descriptive. Therefore, one has to examine the relevance of these findings. Some analyses have cast doubt as to whether one can simply assume that the more disorders a patient suffers from, the more impaired he or she is (Strakowski et al., 1992; Brieger et al., 2002a). Nevertheless, in several studies, comorbidity tended to be a complicating factor (Zimmerman and Mattia, 2000; McDermut et al., 2001). In addition to other elements, it may lead to an increase in the length of hospital stay (Wancata et al., 2001).

A useful definition of comorbidity is the “joint occurrence of two or more mental disorders occurring with each other and/or with medical conditions” (Klerman, 1990). Classical psychiatrists, such as Karl Jaspers (1973), postulated that all signs of an illness should be subsumed under a single diagnosis, which usually implies that this “main diagnosis” is meaningful in terms of prognosis and outcome.

Type
Chapter
Information
Bipolar Disorders
Mixed States, Rapid Cycling and Atypical Forms
, pp. 263 - 276
Publisher: Cambridge University Press
Print publication year: 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, H. S. (1996). The temperamental foundations of affective disorders. In Interpersonal Factors in the Origin and Course of Affective Disorders, ed. Mundt, C., Hahlweg, K., and Fiedler, P., pp. 3–30. London: Gaskell.
Akiskal, H. S. and Pinto, O. (2000). Soft bipolar spectrum: footnotes to Kraepelin on the interface of hypomania, temperament and depression. In Bipolar Disorders: 100 Years after Manic-Depressive Insanity, ed. Marneros, A. and Angst, J., pp. 37–62. Dordrecht: Kluwer Academic Publishers.
Akiskal, H. S., Hirschfeld, R. M., and Yerevanian, B. I. (1983). The relationship of personality to affective disorders. Arch. Gen. Psychiatry, 40, 801–10.CrossRefGoogle Scholar
Akiskal, H. S., Hantouche, E. G., Bourgeois, M. L., et al. (1998). Gender, temperament, and the clinical picture in dysphoric mixed mania: findings from a French national study (EPIMAN). J. Affect. Disord., 50, 175–86.Google Scholar
Akiskal, H. S., Brieger, P., Mundt, C., Angst, J., and Marneros, A. (2002). Temperament und affektive Störungen. Die TEMPS-A Skala als Konvergenz europäischer und US-amerikanischer Konzepte. [Temperament and affective disorders. The TEMPS-A scale as a convergence of European and US-American concepts.] Nervenarzt, 73, 262–71.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.
Bamrah, J. S. and Johnson, J. (1991). Bipolar affective disorder following head injury. Br. J. Psychiatry, 158, 117–19.CrossRefGoogle Scholar
Bartalena, L., Pellegrini, L., Meschi, M., et al. (1990). Evaluation of thyroid function in patients with rapid-cycling and non-rapid-cycling bipolar disorder. Psychiatry Res., 34, 13–17.CrossRefGoogle Scholar
Basso, M. R., Lowery, N., Neel, J., Purdie, R., and Bornstein, R. A. (2002). Neuropsychological impairment among manic, depressed, and mixed-episode inpatients with bipolar disorder. Neuropsychology, 16, 84–91.CrossRefGoogle Scholar
Bauer, M. S., Whybrow, P. C., and Winokur, A. (1990). Rapid cycling bipolar affective disorder. I. Association with grade I hypothyroidism. Arch. Gen. Psychiatry, 47, 427–32.Google Scholar
Berthier, M. L. (1992). Post-stroke rapid cycling bipolar affective disorder. Br. J. Psychiatry, 160, 283.CrossRefGoogle Scholar
Brady, K., Casto, S., Lydiard, R. B., Malcolm, R., and Arana, G. (1991). Substance abuse in an inpatient psychiatric sample. Am. J. Drug Alcohol Abuse, 17, 389–97.CrossRefGoogle Scholar
Brieger, P. (2000). Comorbidity in bipolar disorder. In Bipolar Disorders: 100 Years after Manic-Depressive Insanity, ed. Marneros, A. and Angst, J., pp. 215–29. Dordrecht: Kluwer Academic Publishers.
Brieger, P. and Marneros, A. (2000). Komorbidität bei psychiatrischen Störungen. Einige theoretische Überlegungen. [Comorbidity in psychiatric diseases. Some theoretical considerations.] Nervenarzt, 71, 525–34.Google Scholar
Brieger, P., Ehrt, U., Bloeink, R., and Marneros, A. (2002a). Consequences of comorbid personality disorders in major depression. J. Nerv. Ment. Dis, 190, 304–9.Google Scholar
Brieger, P., Ehrt, U., Roettig, S., and Marneros, A. (2002b). Personality features of patients with mixed and pure manic episodes. Acta Psychiatr. Scand, 106, 179–82.Google Scholar
Brieger, P., Ehrt, U., and Marneros, A. (2003a). Frequency of comorbid personality disorders in bipolar and unipolar affective disorders. Compr. Psychiatry, 44, 28–34.Google Scholar
Brieger, P., Roettig, S., Ehrt, U., et al. (2003b). TEMPS-A scale in ‘mixed’ and ‘pure’ manic episodes: new data and methodological considerations on the relevance of joint anxious-depressive temperament traits. J. Affect. Disord, 73, 99–104.Google Scholar
Brieger, P. (in press). The Relevance of Comorbidity for Atypical Forms of Bipolar Affective Disorders. Clin. Neuropsychiatry: J. Treatment Eval. (in press).
Calabrese, J., Rapport, D., Findling, R., Shelton M., and Kimmel, S. (2000). Rapid-cycling bipolar disorder. In Bipolar Disorders: 100 Years After Manic-Depressive Insanity, ed. Marneros, A., and Angst, J., pp. 89–109. Dordrecht: Kluwer Academic Publishers.
Cassidy, F., Forest, K., Murry, E. and Carroll, B. J. (1998a). A factor analysis of the signs and symptoms of mania. Arch. Gen. Psychiatry, 55, 27–32.Google Scholar
Cassidy, F., Forest, K., Murry, E. and Carroll, B. J. (1998b). Signs and symptoms of mania in pure and mixed episodes. J. Affect. Disord, 50, 187–201.Google Scholar
Cassidy, F., Ahearn, E., Murry, E., Forest, K., and Carroll, B. J. (2000). Diagnostic depressive symptoms of the mixed bipolar episode. Psychol. Med, 30, 403–11.CrossRefGoogle Scholar
Cassidy, F., Ahearn, E. P., and Carroll, B. J. (2001a). Substance abuse in bipolar disorder. Bipolar Disord., 3, 181–8.Google Scholar
Cassidy, F., Pieper, C. F., and Carroll, B. J. (2001b). Subtypes of mania determined by grade of membership analysis. Neuropsychopharmacology, 25, 373–83.Google Scholar
Cassidy, F., Ahearn, E. P., and Carroll, B. J. (2002). Thyroid function in mixed and pure manic episodes. Bipolar Disord., 4. 393–7.Google Scholar
Chang, K. D., Keck, P. E. Jr., Stanton, S. P., et al. (1998). Differences in thyroid function between bipolar manic and mixed states. Biol. Psychiatry, 43, 730–3.Google Scholar
Chen, Y. W. and Dilsaver, S. C. (1995a). Comorbidity for obsessive-compulsive disorder in bipolar and unipolar disorders. Psychiatry Res., 59, 57–64.Google Scholar
Chen, Y. W. and Dilsaver, S. C. (1995b). Comorbidity of panic disorder in bipolar illness: evidence from the Epidemiologic Catchment Area survey. Am. J. Psychiatry, 152, 280–2.Google Scholar
Costa, P. T. and Widiger, T. A. (eds) (1994). Personality Disorders and the Five-Factor Model of Personality. Washington, DC: American Psychological Association.CrossRef
Cowdry, R. W., Wehr, T. A., Zis, A. P., and Goodwin, F. K. (1983). Thyroid abnormalities associated with rapid-cycling bipolar illness. Arch. Gen. Psychiatry, 40, 414–20.CrossRefGoogle Scholar
Dell'Osso, L., Placidi, G. F., Nassi, R., et al. (1991). The manic depressive mixed state: familial, temperamental and psychopathologic characteristics in 108 female inpatients. Eur. Arch. Clin. Neurosci., 240, 234–9.Google Scholar
Dell'Osso, L., Pini, S., Tundo, A., et al. (2000). Clinical characteristics of mania, mixed mania, and bipolar depression with psychotic features. Compr. Psychiatry, 41, 242–7.CrossRefGoogle Scholar
Extein, I., Pottash, A. L. and Gold, M. S. (1982). Does subclinical hypothyroidism predispose to tricyclic-induced rapid mood cycles?J. Clin. Psychiatry, 43, 290–1.Google Scholar
Feske, U., Frank, E., Mallinger, A. G., et al. (2000). Anxiety as a correlate of response to the acute treatment of bipolar I disorder. Am. J. Psychiatry, 157, 956–62.CrossRefGoogle Scholar
Geller, B., Craney, J. L., Bolhofner, K., et al. (2002a). Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar disorder phenotype. Am. J. Psychiatry, 159, 927–33.Google Scholar
Geller, B., Zimerman, B., Williams, M., et al. (2002b). DSM-IV mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype compared to attention-deficit hyperactive and normal controls. J. Child Adolesc. Psychopharmacol., 12, 11–25.Google Scholar
Geller, B., Zimerman, B., Williams, M., et al. (2002c). Phenomenology of prepubertal and early adolescent bipolar disorder: examples of elated mood, grandiose behaviors, decreased need for sleep, racing thoughts and hypersexuality. J. Child Adolesc. Psychopharmacol., 12, 3–9.Google Scholar
Goldberg, J. F., Garno, J. L., Leon, A. C., Kocsis, J. H., and Portera, L. (1999). A history of substance abuse complicates remission from acute mania in bipolar disorder. J. Clin. Psychiatry, 60, 733–40.CrossRefGoogle Scholar
Hagenah, U., Coners, H., Kotlarek, F., and Herpertz-Dahlmann, B. (1999). Tuberöse Sklerose und organische bipolare Störung bei einer 15 jährigen Jugendlichen. [Tuberous sclerosis and organic bipolar disorder in a 15-year-old adolescent.] Z. Kinder Jugendpsychiatr. Psychother, 27, 283–9.CrossRefGoogle Scholar
Himmelhoch, J. M., Mulla, D., Neil, J. F., Detre, T. P., and Kupfer, D. J. (1976). Incidence and signficiance of mixed affective states in a bipolar population. Arch. Gen. Psychiatry, 33, 1062–6.CrossRefGoogle Scholar
Jan, J. E., Abroms, I. F., Freeman, R. D., et al. (1994). Rapid cycling in severely multidisabled children: a form of bipolar affective disorder?Pediatr. Neurol., 10, 34–9.Google Scholar
Jaspers, K. (1973). Allgemeine Psychopathologie, 9th edn. Berlin: Springer.
Joffe, R. T., Kutcher, S. and MacDonald, C. (1988). Thyroid function and bipolar affective disorder. Psychiatry Res., 25, 117–21.CrossRefGoogle Scholar
Joffe, R. T., Young, L. T., Cooke, R. G., and Robb, J. (1994). The thyroid and mixed affective states. Acta Psychiatr. Scand., 90, 131–2.CrossRefGoogle Scholar
Kahlbaum, K. L. (1863). Die Gruppierung der psychischen Krankheiten und die Einteilung der Seelenstörungen. Danzig: A. W. Kafemann.
Keller, M. B., Lavori, P. W., Coryell, W., et al. (1986). Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness. J. A. M. A., 255, 3138–42.CrossRef
Kessler, R. C. (1999). Comorbidity of unipolar and bipolar depression with other psychiatric disorders in a general population survey. In Comorbidity in Affective Disorders, ed. Tohen, M., pp. 1–25 New York: Marcel Dekker.
Klerman, G. L. (1990). Approaches to the phenomena of comorbidity. In Comorbidity of Mood and Anxiety Disorders, ed. Maser, J. D. and Cloninger, C. R., pp. 13–37. Washington, DC: American Psychiatric Press.
Koukopoulos, A. and Koukopoulos, A. (1999). Agitated depression as a mixed state and the problem of melancholia. Psychiatr. Clin. North Am., 22, 547–64.CrossRefGoogle Scholar
Kraepelin, E. (1909–1915). Psychiatrie. Ein Lehrbuch für Studierende und Ärzte. 8 Aufl. Leipzig: Johann Ambrosius Barth.
Kudo, T., Ishida, S., Kubota, H., and Yagi, K. (2001). Manic episode in epilepsy and bipolar I disorder: a comparative analysis of 13 patients. Epilepsia, 42, 1036–42.CrossRefGoogle Scholar
Kupka, R. W., Nolen, W. A., Post, R. M., et al. (2002). High rate of autoimmune thyroiditis in bipolar disorder: lack of association with lithium exposure. Biol. Psychiatry, 51, 305–11.Google Scholar
Lauterbach, E. C., Spears, T. E., and Price, S. T. (1992). Bipolar disorder in idiopathic dystonia: clinical features and possible neurobiology. J. Neuropsychiatry Clin. Neurosci., 4, 435–9.CrossRefGoogle Scholar
Lish, J. D., Gyulai, L., Resnick, S. M., et al. (1993). A family history study of rapid-cycling bipolar disorder. Psychiatry Res., 48, 37–46.CrossRefGoogle Scholar
Livesley, W. J. (1998). Suggestions for a framework for an empirically based classification of personality disorder. Can. J. Psychiatry, 43, 137–47.CrossRefGoogle Scholar
Marneros, A. and Brieger, P. (2002). The prognosis of bipolar disorder: a review. In Bipolar Disorders. WPA series vol. 5, ed. Maj, M., Sartorius, N., Ibor, J.-J. L., and Akiskal, H. S., pp. 97–148, Chichester: Wiley.
Maser, J. and Patterson, T. (2002). Spectrum and nosology: implications for DSM-V. Psychiatr. Clin. North America., 25, 855–85.CrossRefGoogle Scholar
McDermut, W., Mattia, J. and Zimmerman, M. (2001). Comorbidity burden and its impact on psychosocial morbidity in depressed outpatients. J. Affect. Disord., 65, 289–95.Google Scholar
McElroy, S. L., Strakowski, S. M., Keck, P. E. Jr., et al. (1995). Differences and similarities in mixed and pure mania. Compr. Psychiatry, 36, 187–94.CrossRefGoogle Scholar
McElroy, S. L., Freeman, M. P., and Akiskal, H. S. (2000). The mixed bipolar disorders. In Bipolar Disorders: 100 Years after Manic-Depressive Insanity. ed. Marneros, A. and Angst, J., pp. 63–88 Dordrecht: Kluwer Academic Publishers.
McElroy, S. L., Altshuler, L. L., Suppes, T., et al. (2001). Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. Am. J. Psychiatry, 158, 420–6.CrossRefGoogle Scholar
Merikangas, K. R. (1990). Comorbidity for anxiety and depression: reviews of family and genetic studies. In Comorbidity of Mood and Anxiety Disorders, ed. Maser, J. D. and Cloninger, C. R., pp. 331–48. Washington, DC: American Psychiatric Press.
Oomen, H. A., Schipperijn, A. J., and Drexhage, H. A. (1996). The prevalence of affective disorder and in particular of a rapid cycling of bipolar disorder in patients with abnormal thyroid function tests. Clin. Endocrinol. (Oxf.), 45, 215–23.CrossRefGoogle Scholar
Perugi, G., Toni, C., and Akiskal, H. (1999). Anxious-bipolar comorbidity. Diagnostic and treatment challenges. Psychiatr. Clin. North Am., 22, 565–83.CrossRefGoogle Scholar
Perugi, G., Akiskal, H. S., Toni, C., Simonini, E. and Gemignani, A. (2001). The temporal relationship between anxiety disorders and (hypo)mania: a retrospective examination of 63 manic, social phobic and obsessive-compulsive patients with comorbid bipolar disorder. J. Affect. Disord., 67, 199–206.CrossRefGoogle Scholar
Post, R. M., Rubinow, D. R., Uhde, T. W., et al. (1989). Dysphoric mania. Clinical and biological correlates. Arch. Gen. Psychiatry, 46, 353–8.CrossRefGoogle Scholar
Raghavan, R., Day, K. A., and Perry, R. H. (1995). Rapid cycling bipolar affective disorder and familial learning disability associated with temporal lobe (occipitotemporal gyrus) cortical dysplasia. J. Intellect. Disabil. Res., 39, 509–19.CrossRefGoogle Scholar
Reinelt, Y. (2003). Paraklinische Befunde bei gemischten Episoden bipolar affektiver und schizoaffektiver Erkrankungen. [Paraclinical findings in patients with mixed bipolar affective and mixed bipolar schizoaffective episodes.] Medical thesis. Halle/Saale: Martin-Luther-University Halle-Wittenberg.
Rundell, J. R. and Wise, M. G. (1989). Causes of organic mood disorder. J. Neuropsychiatry Clin. Neurosci., 1, 398–400.CrossRefGoogle Scholar
Sonne, S. C. and Brady, K. T. (1999). Bipolar disorder and substance abuse. In Comorbidity in Affective Disorders, ed. Tohen, M., pp. 197–212. New York; Marcel Dekker.
Sonne, S. C., Brady, K. T., and Morton, W. A. (1994). Substance abuse and bipolar affective disorder. J. Nerv. Ment. Dis., 182, 349–52.CrossRefGoogle Scholar
Spitzer, R. L. (1998). Diagnosis and need for treatment are not the same. Arch. Gen. Psychiatry, 55, 120.CrossRefGoogle Scholar
Strakowski, S. M., Tohen, M., Stoll, A. L., Faedda, G. L., and Goodwin, D. C. (1992). Comorbidity in mania at first hospitalization. Am. J. Psychiatry, 149, 554–6.CrossRefGoogle Scholar
Strakowski, S. M., Sax, K. W., McElroy, S. L., et al. (1998). Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization. J. Clin. Psychiatry, 59, 465–71.CrossRefGoogle Scholar
Swann, A. C., Secunda, S. K., Katz, M. M., et al. (1993). Specificity of mixed affective states: clinical comparison of dysphoric mania and agitated depression. J. Affect. Disord., 28, 81–9.CrossRefGoogle Scholar
Vieta, E., Colom, F., Corbella, B., et al. (2001). Clinical correlates of psychiatric comorbidity in bipolar I patients. Bipolar Disord., 3, 253–8.CrossRefGoogle Scholar
Walbridge, D.G. (1990). Rapid-cycling disorder in association with cerebral sarcoidosis. Br. J. Psychiatry, 157, 611–13.CrossRefGoogle Scholar
Wancata, J., Benda, N., Windhaber, J., and Nowotny, M., (2001). Does psychiatric comorbidity increase the length of stay in general hospitals?Gen. Hosp. Psychiatry, 23, 8–14.CrossRefGoogle Scholar
Weiss, R. D., Mirin, S. M., Griffin, M. L., and Michael, J. L. (1988). Psychopathology in cocaine abusers. Changing trends. J. Nerv. Ment. Dis., 176, 719–25.CrossRefGoogle Scholar
Winokur, G., Clayton, P., and Reich, T., (1969). Manic-Depressive Illness. St. Louis, MO: Mosby.
Winokur, G., Coryell, W., Akiskal, H. S., et al. (1995). Alcoholism in manic-depressive (bipolar) illness: familial illness, course of illness, and the primary-secondary distinction. Am. J. Psychiatry, 152, 365–72.Google Scholar
Winokur, G., Turvey, C., Akiskal, H., et al. (1998). Alcoholism and drug abuse in three groups – bipolar I, unipolars and their acquaintances. J. Affect. Disord., 50, 81–9.CrossRefGoogle Scholar
World Health Organization (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: World Health Organization.
Zarate, C. A. and Tohen, M., (1999). Bipolar disorder and comorbid axis I disorders. In Comorbidity in Affective Disorders, ed. Tohen, M., pp. 229–39. New York: Marcel Dekker.
Zarate, C. A., Tohen, M., and Zarate, S. B. (1997). Thyroid function tests in first-episode bipolar disorder manic and mixed types. Biol. Psychiatry, 42, 302–4.CrossRefGoogle Scholar
Zimmerman, M. and Mattia, J. I. (2000). Principal and additional DSM-IV disorders for which outpatients seek treatment. Psychiatr. Serv., 51, 1299–304.CrossRefGoogle Scholar
Zwil, A. S., McAllister, T. W., Cohen, I., and Halpern, L. R. (1993). Ultra-rapid cycling bipolar affective disorder following a closed-head injury. Brain Inj., 7, 147–52.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×