Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

114 J. Angst et al.than 2 weeks, usually 1–3 days) and frequent recurrence (at least monthly overthe previous 12 months) plus work impairment(2) The definition of RBM required the presence of a hypomanic syndrome(Angst et al., 2003a) of brief duration (1–3 days) and frequent recurrence(at least monthly over the previous 12 months). In addition, we tentativelydefined a diagnosis of recurrent brief hypomanic symptoms (RBMS) withbrief duration and high recurrence(3) RBA was diagnosed in the presence of a DSM-III syndrome of generalizedanxiety disorder of brief duration (less than 2 weeks) and frequent recurrence(at least monthly over the previous 12 months; Angst and Wicki, 1992).Combined syndromesThis paper will concentrate on combined major depression and combined bipolardisorders.As stated earlier, we defined combined major depression as the association ofMDD with RBD; combined BP-II disorders as the association of BP-II with RBD;and combined MinBP as the association of MinBP with RBD. The combinedgroups will be compared with the pure groups in order to test the hypothesis thatthe combined are more severe than the pure syndromes.Rapid cycling and seasonalityRapid cycling was diagnosed if the subjects reported having suffered from four ormore episodes of depression or hypomania per year; brief episodes with a lengthunder the diagnostic thresholds of DSM-IV were included.Seasonality was assessed by questions on the presence of the episodes in spring,summer, fall, and winter.Treatment and distressTreatment was defined as consultation of doctors or psychologists for moodsyndromes. Distress as a consequence of manic and depressive symptoms wasestimated on an analogue scale from 0 to 100 (thermometer) over the 12 monthsprior to the interview.PersonalityA personality trait of mood instability (ups and downs) was assessed by thequestion: ‘‘Would you say you were one of those people who have frequent upsand downs?’’A diagnosis of depressive personality disorder (DPD) was derived from theGeneral Behavior Inventory of Depue et al. (1981; items 16, 20, 36, 47, 56, 62, 71