Rapid switching of mood in families with multiple cases of bipolar disorder

Dean F. MacKinnon, Peter P. Zandi, Elliot Gershon, John Nurnberger, Theodore Reich, J. Raymond DePaulo

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Background: Heterogeneity within the diagnostic construct of bipolar disorder is most likely an obstacle to discovering its causes. Phenomena in the bipolar spectrum, including rapid cycling, cyclothymia, and affective instability of borderline personality, may be important markers of etiologic heterogeneity. Rapid switching of mood may be central to these phenomena. Methods: We performed a case-control study, using diagnostic data from a multisite bipolar disorder linkage study, to explore clinical and demographic factors potentially related to rapid switching in bipolar disorder. Participants were 18 years or older and members of a family in which 2 or more first-degree relatives had bipolar disorder. Of 718 individuals interviewed and diagnosed as having bipolar disorder, 603 gave sufficient information about rapid switching and thus constituted the study group (60% female; mean age, 41 years; and mean education level, 13.8 years). Results: Rapid switching of mood was reported by 44% of interviewees and was associated with early age at onset of bipolar disorder, higher risk of anxiety and substance abuse or dependence comorbidity, suicide attempts, antidepressant drug use, and having a relative with rapid switching. Conclusions: Rapid switching is associated with a complex clinical course of bipolar disorder. These results extend previous associations among rapid switching, anxiety, substance abuse, and early onset of bipolar disorder to a family study population. Rapid switching of mood seems to be the core phenomenon behind several variants of non-DSM-IV rapid cycling, DSM-III-R mixed states, and borderline personality disorder and the link connecting comorbidity, suicide, and early onset of bipolar disorder. Further biological investigation of the rapid-switching phenomenon is justified on epidemiologic grounds.

Original languageEnglish
Pages (from-to)921-928
Number of pages8
JournalArchives of General Psychiatry
Volume60
Issue number9
DOIs
StatePublished - Sep 1 2003

Fingerprint

Bipolar Disorder
Substance-Related Disorders
Suicide
Comorbidity
Anxiety
Borderline Personality Disorder
Age of Onset
Diagnostic and Statistical Manual of Mental Disorders
Antidepressive Agents
Personality
Case-Control Studies
Demography
Education
Population

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Rapid switching of mood in families with multiple cases of bipolar disorder. / MacKinnon, Dean F.; Zandi, Peter P.; Gershon, Elliot; Nurnberger, John; Reich, Theodore; DePaulo, J. Raymond.

In: Archives of General Psychiatry, Vol. 60, No. 9, 01.09.2003, p. 921-928.

Research output: Contribution to journalArticle

MacKinnon, Dean F. ; Zandi, Peter P. ; Gershon, Elliot ; Nurnberger, John ; Reich, Theodore ; DePaulo, J. Raymond. / Rapid switching of mood in families with multiple cases of bipolar disorder. In: Archives of General Psychiatry. 2003 ; Vol. 60, No. 9. pp. 921-928.
@article{a13d8843968b48dfaf9b3639a7234239,
title = "Rapid switching of mood in families with multiple cases of bipolar disorder",
abstract = "Background: Heterogeneity within the diagnostic construct of bipolar disorder is most likely an obstacle to discovering its causes. Phenomena in the bipolar spectrum, including rapid cycling, cyclothymia, and affective instability of borderline personality, may be important markers of etiologic heterogeneity. Rapid switching of mood may be central to these phenomena. Methods: We performed a case-control study, using diagnostic data from a multisite bipolar disorder linkage study, to explore clinical and demographic factors potentially related to rapid switching in bipolar disorder. Participants were 18 years or older and members of a family in which 2 or more first-degree relatives had bipolar disorder. Of 718 individuals interviewed and diagnosed as having bipolar disorder, 603 gave sufficient information about rapid switching and thus constituted the study group (60{\%} female; mean age, 41 years; and mean education level, 13.8 years). Results: Rapid switching of mood was reported by 44{\%} of interviewees and was associated with early age at onset of bipolar disorder, higher risk of anxiety and substance abuse or dependence comorbidity, suicide attempts, antidepressant drug use, and having a relative with rapid switching. Conclusions: Rapid switching is associated with a complex clinical course of bipolar disorder. These results extend previous associations among rapid switching, anxiety, substance abuse, and early onset of bipolar disorder to a family study population. Rapid switching of mood seems to be the core phenomenon behind several variants of non-DSM-IV rapid cycling, DSM-III-R mixed states, and borderline personality disorder and the link connecting comorbidity, suicide, and early onset of bipolar disorder. Further biological investigation of the rapid-switching phenomenon is justified on epidemiologic grounds.",
author = "MacKinnon, {Dean F.} and Zandi, {Peter P.} and Elliot Gershon and John Nurnberger and Theodore Reich and DePaulo, {J. Raymond}",
year = "2003",
month = "9",
day = "1",
doi = "10.1001/archpsyc.60.9.921",
language = "English",
volume = "60",
pages = "921--928",
journal = "JAMA Psychiatry",
issn = "2168-622X",
publisher = "American Medical Association",
number = "9",

}

TY - JOUR

T1 - Rapid switching of mood in families with multiple cases of bipolar disorder

AU - MacKinnon, Dean F.

AU - Zandi, Peter P.

AU - Gershon, Elliot

AU - Nurnberger, John

AU - Reich, Theodore

AU - DePaulo, J. Raymond

PY - 2003/9/1

Y1 - 2003/9/1

N2 - Background: Heterogeneity within the diagnostic construct of bipolar disorder is most likely an obstacle to discovering its causes. Phenomena in the bipolar spectrum, including rapid cycling, cyclothymia, and affective instability of borderline personality, may be important markers of etiologic heterogeneity. Rapid switching of mood may be central to these phenomena. Methods: We performed a case-control study, using diagnostic data from a multisite bipolar disorder linkage study, to explore clinical and demographic factors potentially related to rapid switching in bipolar disorder. Participants were 18 years or older and members of a family in which 2 or more first-degree relatives had bipolar disorder. Of 718 individuals interviewed and diagnosed as having bipolar disorder, 603 gave sufficient information about rapid switching and thus constituted the study group (60% female; mean age, 41 years; and mean education level, 13.8 years). Results: Rapid switching of mood was reported by 44% of interviewees and was associated with early age at onset of bipolar disorder, higher risk of anxiety and substance abuse or dependence comorbidity, suicide attempts, antidepressant drug use, and having a relative with rapid switching. Conclusions: Rapid switching is associated with a complex clinical course of bipolar disorder. These results extend previous associations among rapid switching, anxiety, substance abuse, and early onset of bipolar disorder to a family study population. Rapid switching of mood seems to be the core phenomenon behind several variants of non-DSM-IV rapid cycling, DSM-III-R mixed states, and borderline personality disorder and the link connecting comorbidity, suicide, and early onset of bipolar disorder. Further biological investigation of the rapid-switching phenomenon is justified on epidemiologic grounds.

AB - Background: Heterogeneity within the diagnostic construct of bipolar disorder is most likely an obstacle to discovering its causes. Phenomena in the bipolar spectrum, including rapid cycling, cyclothymia, and affective instability of borderline personality, may be important markers of etiologic heterogeneity. Rapid switching of mood may be central to these phenomena. Methods: We performed a case-control study, using diagnostic data from a multisite bipolar disorder linkage study, to explore clinical and demographic factors potentially related to rapid switching in bipolar disorder. Participants were 18 years or older and members of a family in which 2 or more first-degree relatives had bipolar disorder. Of 718 individuals interviewed and diagnosed as having bipolar disorder, 603 gave sufficient information about rapid switching and thus constituted the study group (60% female; mean age, 41 years; and mean education level, 13.8 years). Results: Rapid switching of mood was reported by 44% of interviewees and was associated with early age at onset of bipolar disorder, higher risk of anxiety and substance abuse or dependence comorbidity, suicide attempts, antidepressant drug use, and having a relative with rapid switching. Conclusions: Rapid switching is associated with a complex clinical course of bipolar disorder. These results extend previous associations among rapid switching, anxiety, substance abuse, and early onset of bipolar disorder to a family study population. Rapid switching of mood seems to be the core phenomenon behind several variants of non-DSM-IV rapid cycling, DSM-III-R mixed states, and borderline personality disorder and the link connecting comorbidity, suicide, and early onset of bipolar disorder. Further biological investigation of the rapid-switching phenomenon is justified on epidemiologic grounds.

UR - http://www.scopus.com/inward/record.url?scp=0141791116&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0141791116&partnerID=8YFLogxK

U2 - 10.1001/archpsyc.60.9.921

DO - 10.1001/archpsyc.60.9.921

M3 - Article

VL - 60

SP - 921

EP - 928

JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-622X

IS - 9

ER -