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

79 Rapid-cycling bipolar disorderantibodies (TPO-Abs) of outpatients with DSM-IV bipolar disorder (n ¼ 226), apopulation control group (n ¼ 252), and psychiatric inpatients of any diagnosis(n ¼ 3190) were measured. The TPO-Abs were more prevalent in bipolar patients(28%) than population and psychiatric controls (3–18%). The presence of TPO-Abs in bipolar patients was associated with thyroid failure, but not with age,gender, mood state, rapid cycling, or lithium exposure. Thyroid failure was presentin 17% of bipolar patients and more prevalent in women. It was associated withlithium exposure, especially in the presence of TPO-Abs, but not with currentrapid cycling, although an association may have been masked by thyroid hormonereplacement. The authors concluded that thyroid autoimmunity was highly prevalentin this sample of outpatients with bipolar disorder and not associated withlithium treatment. These variables appear to be independent risk factors for thedevelopment of hypothyroidism, especially in women with bipolar disorder.Divalproex sodiumSwann (2001) analyzed the prediction of treatment response in acute mania incontrolled clinical trials with divalproex. For predictive factors, 179 subjects inthree parallel groups (divalproex, lithium, and placebo) were evaluated over aperiod of 21 days by using structured interviews. For the follow-on study, 372stabilized patients were randomized to three groups: divalproex, lithium, orplacebo. The results showed that patients with manic episodes with depressivesymptoms or with rapid cycling exhibited good response to divalproex. It wasconcluded that a high number of both manic and depressive prior episodes ispredictive of poor response to lithium and favorable response to divalproex. Theresults of this study add to the available evidence of the utility of divalproexsodium in the treatment of rapid-cycling bipolar disorder.OlanzapineThere have been few reports about the use of olanzapine in rapid-cycling bipolardisorder (Demopulos et al., 2000; Bhana and Perry, 2001), Demopulos et al.(2000) published a preliminary report of a cohort of patients with rapidly cyclingbipolar I disorder who participated in the double-blind, placebo-controlled3-week study of acute mania. Their results indicated that olanzapine 5–20 mg/daymonotherapy (n ¼ 19) was significantly superior to placebo (n ¼ 25) in improvingYMRS scores relative to baseline ( 14 versus 4, P ¼ 0.05). Additionally, significantlymore olanzapine than placebo recipients had improvements of 30%from baseline YMRS scores (84 versus 36%, P ¼ 0.002). However, their samplesize was too small to draw any generalizable conclusions.