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Ultra-Rapid and Ultradian Cycling in Bipolar Affective Illness

Published online by Cambridge University Press:  02 January 2018

Keith G. Kramlinger  and
Robert M. Post
Keith G. Kramlinger
Affiliation:
Biological Psychiatry Branch, NIMH
Robert M. Post*
Affiliation:
Biological Psychiatry Branch, NIMH
*
Robert M. Post, Biological Psychiatry Branch, NIMH, Bldg. 10, Room 3N212, 10 Center Drive MSC 1272, Bethesda MD 20892-1272. Fax (301) 402 0052
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Abstract

Background

Rapid-cycling bipolar disorder is defined as four or more affective episodes yearly. The conventionally recognised limit in episode duration is usually considered 24 hours (i.e. a cycle duration of 48 hours). We report a small series of intensively observed bipolar patients who showed much faster patterns of mood oscillation.

Methods

Detailed, systematic, longitudinal assessment of five bipolar patients during extended in-patient psychiatric evaluation were conducted, including retrospective life charting and prospective evaluation of daily mood by self and blinded observer ratings, and motor activity recording.

Results

Our data demonstrate a spectrum of cycling frequencies in rapid-cyclers, including distinct, clinically robust mood shifts that occur at frequencies faster than once per 24 hours. Affective oscillations spanned a range of cycling frequencies from four episodes per year (rapid cycling) to those occurring within the course of weeks to several days (ultra-rapid cycling), to distinct, abrupt mood shifts of less than 24 hours' duration (ultra-ultra rapid or ultradian cycling). The time of onset and duration of these ultradian affective fluctuations are highly variable and they are observed in bipolar patients without evidence of personality disorder.

Conclusions

The potential clinical and theoretical implications of these first systematic observations of ultra-rapid and ultradian cycling in the context of the evolution of otherwise classical bipolar affective illness are discussed.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 168 , Issue 3 , March 1996 , pp. 314 - 323
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.Google Scholar
Angst, J., Merikangas, K., Scheidegger, P., et al (1990) Recurrent brief depression: a new subtype of affective disorder. Journal of Affective Disorders, 19, 87–98.CrossRefGoogle ScholarPubMed
Bunney, W. E. Jr & Hartmann, E. L. (1965) Study of a patient with 48-hour manic–depressive cycles. Part I. An analysis of behavioral factors. Archives of General Psychiatry, 12, 611–618.Google Scholar
Cowdry, R. W., Gardner, D. L., O'Leary, K. M., et al (1991) Mood variability: a study of four groups. American Journal of Psychiatry, 148, 1505–1511.Google ScholarPubMed
Doerr, P., Von Zerssen, D., Fischler, M., et al (1979) Relationship between mood changes and adrenal cortical activity in a patient with 48-hour unipolar–depressive cycles. Journal of Affective Disorders, 1, 93–104.Google Scholar
Dunner, D. L., Patrick, V. & Fieve, R. R. (1977) Rapid cycling manic depressive patients. Comprehensive Psychiatry, 18, 561–566.Google Scholar
Elkoshi, Z. (1994) Concentration–effect relationships following levodopa/carbidopa administration to “on–off” Parkinsonian patients. Clinical Neuropharmacology, 17, 147–164.CrossRefGoogle Scholar
Gelenberg, A. J., Klerman, G. L., Hartmann, E. L., et al (1978) Recurrent unipolar depressions with a 48-hour cycle: report of a case. British Journal of Psychiatry, 133, 123–129.Google Scholar
George, M. S., Jones, M., Post, R. M., et al (1996) The longitudinal course of affective illness: a mathematical model involving chaos theory. Psychiatry Research, in press.Google Scholar
Goldberger, A. L., Rigney, D. R. & West, B. J. (1990) Chaos and fractals in human physiology. Scientific American, 262, 43–49.CrossRefGoogle ScholarPubMed
Goodwin, F. K. & Jamison, K. R. (1990) Manic–Depressive Illness. New York: Oxford University Press.Google Scholar
Gottschalk, A., Bauer, M. & Whybrow, P. (1990) Evidence for chaotic attractor in bipolar affective disorder. Biological Psychiatry [Supplement], 27, 99A.Google Scholar
Jenner, F. A., Gjessing, L. R., Cox, J. R., et al (1967) A manic depressive psychotic with a persistent forty-eight hour cycle. British Journal of Psychiatry, 113, 895–910.Google Scholar
Kripke, D. F. (1974) Ultradian rhythms in sleep and wakefulness. In Advances in Sleep Research (ed. Weitzman, E. D.), pp. 305–322. New York: Spectrum.Google Scholar
Kukopulos, A., Caliari, B., Tundo, A., et al (1983) Rapid cyclers, temperament, and antidepressants. Comprehensive Psychiatry, 24, 249–258.CrossRefGoogle ScholarPubMed
Luria, R. E. (1975) The validity and reliability of the visual analogue mood scale. Journal of Psychiatric Research, 12, 51–57.CrossRefGoogle ScholarPubMed
Montgomery, S. A., Montgomery, D., Baldwin, D., et al (1990) The duration, nature and recurrence rate of brief depressions. Progress in Neuropsychopharmacology & Biological Psychiatry, 14, 729–735.Google Scholar
Pazzaglia, P. J., Post, R. M., Ketter, T. A., et al (1993) Preliminary controlled trial of nimodipine in ultra-rapid cycling affective dysregulation. Psychiatry Research, 49, 257–272.Google Scholar
Post, R. M., Rubinow, D. R. & Ballenger, J. C. (1986a) Conditioning and sensitisation in the longitudinal course of affective illness. British Journal of Psychiatry, 149, 191–201.CrossRefGoogle ScholarPubMed
Post, R. M., Uhde, T. W., Roy-Byrne, P. P., et al (1986b) Antidepressant effects of carbamazepine. American Journal of Psychiatry, 143, 29–34.Google Scholar
Post, R. M., Roy-Bryne, P. P. & Uhde, T. W. (1988) Graphic representation of the life course of illness in patients with affective disorder. American Journal of Psychiatry, 145, 844–848.Google ScholarPubMed
Post, R. M., Kramlinger, K. G., Altshuler, L. L., et al (1990) Treatment of rapid cycling bipolar illness. Psychopharmacology Bulletin, 26, 37–47.Google Scholar
Siever, L. J., Teicher, M., Coccardo, E., et al (1989) Disruption of noradrenergic rhythm in depression. Proceedings of 142nd Annual Mtg, New Research Abstracts, NR226, p. 132. American Psychiatric Association: San Francisco.Google Scholar
Silberman, E. K., Post, R. M., Nurnberger, J., et al (1985) Transient sensory, cognitive and affective phenomena in affective illness: a comparison with complex partial epilepsy. British Journal of Psychiatry, 146, 81–89.Google Scholar
Sitaram, N., Gillin, J. C. & Bunney, W. E. Jr (1978) Circadian variation in the time of switch of a patient with 48-hour manic–depressive cycles. Biological Psychiatry, 13, 567–574.Google ScholarPubMed
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research diagnostic criteria. Rationale and reliability. Archives of General Psychiatry, 35, 773–782.Google Scholar
Stangl, D., Pfohl, B., Zimmerman, M., et al (1985) A structured interview for DSM–III personality disorders: a preliminary report. Archives of General Psychiatry, 42, 591–596.CrossRefGoogle ScholarPubMed
Wolff, E. A., Putnam, F. W. & Post, R. M. (1985) Motor activity and affective illness. The relationship of amplitude and temporal distribution to changes in affective state. Archives of General Psychiatry, 42, 288–294.Google Scholar
Wolpert, E. A., Goldberg, J. F. & Harrow, M. (1990) Rapid cycling in unipolar and bipolar affective disorders. American Journal of Psychiatry, 147, 725–728.Google ScholarPubMed
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