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

24 A. Marneros and F. K. GoodwinFig. 1.9Periodic mania with development in folie circulaire (periodische Manie mit Ausgang incirculäres Irresein: Kraepelin, 1913).Rapid cyclingThe term ‘‘rapid cycling’’ is a modern one. However, the phenomenon of frequent,or very frequent, recurrence of manic-depressive and mixed episodes was very wellknown early in the evolution of scientific psychiatry. Emil Kraepelin was perhaps thefirst who systematically described the phenomenon of rapid cycling (1899, 1913).Of course, Kraepelin never used the term ‘‘rapid cycling’’ (Figs. 1.9–1.11). In oneof the earliest uses of the method of retrospective and prospective chart review,Kraepelin documented the frequency and duration of episodes in life charts; hedescribed patients with more than four episodes per year, those with many morethan four episodes, patients with very short symptom-free intervals, and thosewith no free intervals at all (Kraepelin, 1913). However, in the following decades,essentially nothing more was done.The term ‘‘rapid cycling,’’ as well as the increasing interest in this phenomenon,also grew out of the psychopharmacological revolution. Dunner and Fieve firstcoined the term ‘‘rapid cycling’’ in 1974, in what Calabrese et al. called a ‘‘landmarkpaper’’ (Calabrese et al., 2000), which summarized longitudinal data designed toevaluate clinical factors associated with lithium prophylaxis failure. But the