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Bipolar disorder with frequent mood episodes in the national comorbidity survey replication (NCS-R)

Molecular Psychiatry volume 15, pages 1075–1087 (2010)Cite this article

Abstract

Virtually nothing is known about the epidemiology of rapid cycling bipolar disorder (BPD) in community samples. Nationally representative data are reported here for the prevalence and correlates of a surrogate measure of DSM-IV rapid cycling BPD from the National Comorbidity survey Replication (NCS-R), a national survey of the US household population. DSM-IV disorders were assessed in the NCS-R with the WHO Composite International Diagnostic Interview (CIDI). Although the CIDI did not assess rapid cycling, it did assess the broader category of 12-month BPD with frequent mood episodes (FMEs), having at least four episodes of mania/hypomania or major depression in the 12 months before interview. Roughly one-third of NCS-R respondents with lifetime DSM-IV BPD and half with 12-month BPD met criteria for FME. FME was associated with younger age-of-onset (of BP-I, but not BP-II) and higher annual persistence (73% of the years since first onset of illness with an episode) than non-FME BPD. No substantial associations of FME vs non-FME BPD were found with socio-demographics, childhood risk factors (parental mental disorders, other childhood adversities) or comorbid DSM-IV disorders. However, FME manic episodes had greater clinical severity than non-FME episodes (assessed with a fully structured version of the Young Mania Rating Scale) and FME hypomanic episodes had greater role impairment than non-FME episodes (assessed with the Sheehan Disability Scales). Whether these indicators of severity merely reflect attenuated effects of rapid cycling or independent effects of sub-threshold rapid cycling warrants further study given the high proportion of lifetime cases who met criteria for FME.

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Acknowledgements

The National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation (Grant #044780) and the John W Alden Trust. Additional support for preparation of this paper was provided by Ortho-McNeil Janssen Scientific Affairs, LLC. Collaborating NCS-R investigators include Ronald C Kessler (Principal Investigator, Harvard Medical School), Kathleen Merikangas (Co-Principal Investigator, NIMH), James Anthony (Michigan State University), William Eaton (The Johns Hopkins University), Meyer Glantz (NIDA), Doreen Koretz (Harvard University), Jane McLeod (Indiana University), Mark Olfson (Columbia University College of Physicians and Surgeons), Harold Pincus (University of Pittsburgh), Greg Simon (Group Health Cooperative), T Bedirhan Üstün (World Health Organization), Michael Von Korff (Group Health Cooperative), Philip Wang (Harvard Medical School), Kenneth Wells (UCLA), Elaine Wethington (Cornell University) and Hans-Ulrich Wittchen (Max Planck Institute of Psychiatry). The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies or US Government. A complete list of NCS publications and the full text of all NCS-R instruments can be found at http://www.hcp.med.harvard.edu/ncs. Send correspondence to NCS@hcp.med.harvard.edu. The NCS-R is carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centers for assistance with instrumentation, fieldwork and consultation on data analysis. These activities were supported by the John D and Catherine T MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13 MH066849, R01 MH069864, and R01 DA016558), Eli Lilly and Company, GlaxoSmithKline, Ortho-McNeil Pharmaceutical, Inc. and the Pan American Health Organization. A complete list of WMH publications and instruments can be found at (http://www.hcp.med.harvard.edu/wmhcidi). The views expressed in this article do not necessarily represent the view of the NIMH, NIH or HHS of the US Government.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    A A Nierenberg

  2. The International Mood Center, University of California San Diego and VA Psychiatry Service, San Diego, CA, USA

    H S Akiskal

  3. Zurich University Psychiatric Hospital, Zurich, Switzerland

    J Angst

  4. The Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA

    R M Hirschfeld

  5. The Intramural Research Program, Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD, USA

    K R Merikangas

  6. T,

    M Petukhova & R C Kessler

  7. he Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    M Petukhova & R C Kessler

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  1. A A Nierenberg
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Correspondence to R C Kessler.

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Competing interests

In the past 3 years, Dr Nierenberg consulted to or served on advisory boards of Abbott Laboratories, Appliance Computing Inc., Brain Cells Inc., Bristol Myers Squibb, EpiQ, Pam Labs, PGx Health, Forest Pharmaceuticals, Eli Lilly & Co., GlaxoSmithKline, Janssen, Pharmaceutica, Jazz Pharmaceuticals, Merck, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, Schering-Plough, Sepracor, Shire, Somerset, Takeda and Targacept. He has received research support from Cyberonics, Cederroth, Forest Pharmaceuticals, Medtronics, NIMH, NARSAD, the Stanley Foundation through the Broad Institute, Ortho-McNeil-Janssen, Pfizer, Pam Labs and Shire. Past research support includes Bristol Myers Squibb, Cederroth, Forest Pharmaceuticals, Eli Lilly and Company, Glaxo Smith Kline, Janssen, Lictwer Pharma, Pfizer pharmaceuticals and Wyeth Ayerst. He received honoraria from the MGH Psychiatry Academy (MGHPA activities are supported through Independent Medical Education (IME) grants from the following pharmaceutical companies in 2008, Astra Zeneca, Eli Lilly and Janssen Pharmaceuticals), MBL Publishing and Physicians Postgraduate Press. No other speaker bureaus for the past 3 years. Past speaker bureaus include Bristol Myers Squibb, Cyberonics, Forest Pharmaceuticals, Eli Lilly and Company, Glaxo SmithKline and Wyeth Ayerst. Royalties have been received from Cambridge University Press and Belvoir Publishing. Dr Nierenberg owns stock options in Appliance Computing, Inc. He owns copyrights to the Clinical Positive Affect Scale and the MGH Structured Clinical Interview for the Montgomery Asberg Depression Scale exclusively licensed to the MGH Clinical Trials Network and Institute (CTNI).

Dr Akiskal has received honoraria for occasional lectures from GlaxoSmithKline, Abbott, BristolMyerSquibb and AstraZeneca.

Prof Dr Angst has served on the advisory board for Eli Lilly & Company, Janssen Cilag and Sanofi Aventis, and has served on the speakers’ bureau for Eli Lilly & Company and AstraZeneca.

In the last 12 months, Dr Hirschfeld has served as a consultant/advisory board member for Dainippo Sumitomo, Forest Laboratories, Health and Wellness Partners, Pfizer Inc., Takeda; and has received royalties from Compact Clinicals, Taylor and Francis Group, Epocrates, Ogilvy Healthworld, & Merck Manual.

Dr Kessler has been a consultant for GlaxoSmithKline Inc., Kaiser Permanente, Pfizer Inc., Sanofi-Aventis, Shire Pharmaceuticals and Wyeth-Ayerst; has served on advisory boards for Eli Lilly & Company and Wyeth-Ayerst; and has had research support for his epidemiological studies from Bristol-Myers Squibb, Eli Lilly & Company, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho-McNeil Pharmaceuticals Inc., Pfizer Inc. and Sanofi-Aventis.

The remaining authors declare no conflict of interest.

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Nierenberg, A., Akiskal, H., Angst, J. et al. Bipolar disorder with frequent mood episodes in the national comorbidity survey replication (NCS-R). Mol Psychiatry 15, 1075–1087 (2010). https://doi.org/10.1038/mp.2009.61

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