Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-26T20:32:15.026Z Has data issue: false hasContentIssue false

14 - Biological aspects of rapid-cycling and mixed states

Published online by Cambridge University Press:  10 August 2009

By
Heinz Grunze  and
Jörg Walden
Edited by
Andreas Marneros  and
Frederick Goodwin
Heinz Grunze
Affiliation:
Department of Psychiatry, LMU Munich, Germany
Jörg Walden
Affiliation:
Department of Psychiatry, University of Freiburg, Germany
Andreas Marneros
Affiliation:
Martin Luther-Universität Halle-Wittenburg, Germany
Frederick Goodwin
Affiliation:
George Washington University, Washington DC
Get access

Summary

Introduction

Despite the fact that rapid cycling and mixed states are common manifestations of bipolar disorder (Kilzieh and Akiskal, 1999; Akiskal et al., 2000; Grunze et al., 2002a) they have very rarely been subjects of interest for clinical and basic research. As far as clinical research is concerned, rapid cycling and mixed state traditionally were exclusion criteria for controlled randomized phase III studies. This changed just recently, where antiepileptics such as lamotrigine (Calabrese et al., 2000) were tested for their prophylactic efficacy in rapid-cycling patients. As far as mixed states are concerned, recent trials on modern antipsychotics (Keck et al., 2003; Sachs et al., 2002; Tohen et al., 2002) also allowed mixed patients in these studies.

A major problem for including mixed states in studies is the lack of a generally excepted definition. The Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) criteria (fulfillment of all criteria of mania and typical depression at the same time: American Psychiatric Association, 1994) are too narrow, as it has been shown in retrospective analysis of the valproate mania study (Bowden et al., 1994) that one depressive syndrome predicts inferior responsiveness to lithium and better response to valproate (Swann et al., 1997). A commonly used definition is the so-called Cincinnati criteria, which require at least three relevant depressive syndromes (McElroy et al., 1992); however, again, a general consensus on how to define mixed states has not yet been achieved as other views may also have clinical advantages (Perugi et al., 1997).

Keywords

antiepileptic drugsanxiety disordersbipolar disordermixed statesobsessive-compulsive disorderrapid cyclingmood stabilizersnorepinephrinetransmembranous ion fluxes
Type
Chapter
Information
Bipolar Disorders
Mixed States, Rapid Cycling and Atypical Forms
 , pp. 311 - 323
Publisher: Cambridge University Press
Print publication year: 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, H., Bourgeois, M. L., Angst, J., et al. (2000). Re-evaluating tile prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J. Affect. Disord., 59 (suppl. 1), 5–30.Google Scholar
Altrup, U., Gerlach, G., Reith, H., et al. (1992). Effects of valproate in a model nervous system (buccal ganglia of Helix pomatia): I. Antiepileptic actions. Epilepsia, 33, 743–52.CrossRefGoogle Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.
Antia, I. J., Smith, C. E., Wood, A. J., and Aronso, J. K. (1995). The upregulation of Na+, K(+)-ATPase pump numbers in lymphocytes from the first-degree unaffected relatives of patients with manic depressive psychosis in response to in vitro lithium and sodium ethacrynate. J. Affect. Disord., 34, 33–9.CrossRefGoogle Scholar
Bauer, M. S. and Whybrow, P. C. (1990). Rapid cycling bipolar affective disorder. II. Treatment of refractory rapid cycling with high-dose levothyroxine: a preliminary study. Arch. Gen. Psychiatry, 47, 435–40.CrossRefGoogle Scholar
Berridge, M. J. and Irvine, R. F. (1989). Inositol phosphates and cell signalling. Nature, 341, 197–205.CrossRefGoogle Scholar
Bottlender, R., Rudolf, D., Strauss, A., and Moller, H. J. (2000). Are low basal serum levels of the thyroid stimulating hormone (β-TSH) a risk factor for switches into states of expansive syndromes (known in Germany as “maniform syndromes”) in bipolar I depression?Pharmacopsychiatry, 33, 75–7.Google Scholar
Bowden, C. L., Brugger, A. M., Swann, A. C., et al. (1994). Efficacy of divalproex vs lithium and placebo in the treatment of mania. The Depakote Mania Study Group. J. A. M. A., 271, 918–24.CrossRefGoogle Scholar
Buki, V. M. and Goodnick, P. (1998). Catecholamines. In Mania. Clinical and Research Perspectives, ed. Goodnick, P., pp. 119–34. Washington, DC: APA Press.
Calabrese, J. R., Rapport, D. J., Kimmel, S. E., et al. (1993). Rapid cycling bipolar disorder and its treatment with valproate. Can. J. Psychiatry, 38, S57–61.Google Scholar
Calabrese, J. R., Bowden, C. L., Sachs, G. S., et al. (1999). A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. J. Clin. Psychiatry, 60, 79–88.CrossRefGoogle Scholar
Calabrese, J. R., Suppes, T., Bowden, C. L., et al. (2000). A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapid cycling bipolar disorder. J. Clin. Psychiatry., 61, 841–50.CrossRefGoogle Scholar
Cassidy, F., Ritchie, J. C., and Carroll, B. J., (1998). Plasma dexamethasone concentration and cortisol response during manic episodes. Biol. Psychiatry, 43, 747–54.CrossRefGoogle Scholar
Chang, K. D., Keck, P. E., Stanton, S. P., et al. (1998). Differences in thyroid function between bipolar manic and mixed states. Biol. Psychiatry, 43, 730–3.CrossRefGoogle Scholar
Dean, B., Pavey, G., McLeod, M., et al. (2001). A change in the density of [(3)H]flumazenil, but not [(3)H]muscimol binding, in Brodmann's area 9 from subjects with bipolar disorder. J. Affect. Disord., 66, 147–58.CrossRefGoogle Scholar
Diehl, D. J. and Gershon, S. (1992). The role of dopamine in mood disorders. Compr. Psychiatry, 33, 115–20.CrossRefGoogle Scholar
Dunner, D. L. and Fieve, R. R. (1974). Clinical factors in lithium carbonate prophylaxis failure. Arch. Gen. Psychiatry, 30, 229–33.CrossRefGoogle Scholar
el Mallakh, R. S. and Wyatt, R. J. (1995). The Na, K-ATPase hypothesis for bipolar illness. Biol. Psychiatry, 37, 235–44.Google Scholar
Evans, D. L. and Nemeroff, C. B. (1983). The dexamethasone suppression test in mixed bipolar disorder. Am. J. Psychiatry, 140, 615–17.CrossRefGoogle Scholar
Grunze, H., Kammerer, C., and Ackenheil, M. (1997). The neurobiology of bipolar disorder. J. Bipolar Disord., 1 2–12.Google Scholar
Grunze, H., Schlösser, S., Amann, B., and Walden, J. (1999). Clinical research: mechanism of action and indications of anticonvulsants in the treatment of bipolar disorder. Dialogue Clin. Neurosci., 24–40.Google Scholar
Grunze, H., Amann, B., Dittmann, S., and Walden, J. (2002a). Clinical relevance and treatment possibilities of bipolar rapid cycling. Neuropsychobiology, 45 (suppl. 1), 20–6.Google Scholar
Grunze, H., Amann, B., and Walden, J. (2002b). How might anticonvulsant drugs work in bipolar affective disorder? In Seizures, Affective Disorders and Anticonvulsant Drugs, ed. Trimble, M. R. and Schmitz, B., pp. 117–30. Guildford: Clarius Press.
Hollister, L. E. and Trevino, E. S. (1999). Calcium channel blockers in psychiatric disorders: a review of the literature. Can. J. Psychiatry, 44, 658–64.CrossRefGoogle Scholar
Hough, C., Lu, S. J., Davis, C. L., et al. (1999). Elevated basal and thapsigargin-stimulated intracellular calcium of platelets and lymphocytes from bipolar affective disorder patients measured by a fluorometric microassay. Biol. Psychiatry, 46, 247–55.CrossRefGoogle Scholar
Joffe, R. T. and Sokolov, S. T. H. (1997). Hormones and bipolar affective disorder. In Bipolar Disorder–Biological Models and their Clinical Application, ed. Young, L. T. and Joffe, R. T., pp. 81–92. New York: Marcel Dekker.
Joffe, R. T., Young, L. T., Cooke, R. G., and Robb, J. (1994). The thyroid and mixed affective states. Acta Psychiatr. Scand, 90, 131–2.CrossRefGoogle Scholar
Juckel, G., Hegerl, U., Mavrogiorgou, P., et al. (2000). Clinical and biological findings in a case with 48-hour bipolar ultrarapid cycling before and during valproate treatment. J. Clin. Psychiatry, 61, 585–93.CrossRefGoogle Scholar
Kato, T., Murashita, J., Kamiya, A., et al. (1998). Decreased brain intracellular pH measured by 31P-MRS in bipolar disorder: a confirmation in drug-free patients and correlation with white matter hyperintensity. Eur. Arch. Psychiatry Clin. Neurosci., 248, 301–6.CrossRefGoogle Scholar
Keck, P. E., Versiani, M., Potkin, S.et al. (2003). Ziprasidone in the treatment of acute bipolar mania: a three-week, placebo-centrolled, double-blind, randomized trial. Am. J. Psychiatry, 160, 741–8.CrossRefGoogle Scholar
Kelsoe, J. R., Sadovnick, A. D., Kristbjarnarson, H., et al. (1996). Possible locus for bipolar disorder near the dopamine transporter on chromosome 5. Am. J. Med. Genet., 67, 533–40.3.0.CO;2-I>CrossRefGoogle Scholar
Kilzieh, N. and Akiskal, H. S. (1999). Rapid-cycling bipolar disorder. An overview of research and clinical experience. Psychiatr. Clin. North Am., 22, 585–607.CrossRefGoogle Scholar
Krishnan, R. R., Maltbie, A. A., and Davidson, J. R. (1983). Abnormal cortisol suppression in bipolar patients with simultaneous manic and depressive symptoms. Am. J. Psychiatry, 140, 203–5.CrossRefGoogle Scholar
Kupka, R. W., Nolen, W. A., Post, R. M.et al. (2002). High rate of autoimmune thyroiditis in bipolar disorder: lack of association with lithium exposure. Biol. Psychiatry, 51, 305–11.CrossRefGoogle Scholar
Lenox, R. H. and Watson, D. G. (1994). Lithium and the brain: a psychopharmacological strategy to a molecular basis for manic depressive illness. Clin. Chem., 40, 309–14.Google Scholar
Lisman, J. (1994). The CaM kinase II hypothesis for the storage of synaptic memory. Trends Neurosci., 17, 406–12.CrossRefGoogle Scholar
Maes, M., Calabrese, J., Jayathilake, K., and Meltzer, H. Y. (1997). Effects of subchronic treatment with valproate on l-5-HTP-induced cortisol responses in mania: evidence for increased central serotonergic neurotransmission. Psychiatry Res., 71, 67–76.CrossRefGoogle Scholar
Manji, H. K. and Potter, W. Z. (1997). Monoaminergic system. In Bipolar Disorder–Biological Models and their Clinical Application, ed. Young, L. T. and Joffe, R. T., pp. 1–40. New York: Marcel Dekker.
Manki, H., Kanba, S., Muramatsu, T., et al. (1996). Dopamine D2, D3 and D4 receptor and transporter gene polymorphisms and mood disorders. J. Affect. Disord., 40, 7–13.CrossRefGoogle Scholar
Massat, I., Souery, D., Del Favero, J., et al. (2002). Positive association of dopamine D2 receptor polymorphism with bipolar affective disorder in a European Multicenter Association Study of affective disorders. Am. J. Med. Genet., 114, 177.CrossRefGoogle Scholar
McElroy, S. L., Keck, P. E., Pope, H. G., et al. (1992). Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania. Am. J. Psychiatry, 149, 1633–44.CrossRefGoogle Scholar
McElroy, S. L., Freeman, M. P., and Akiskal, H. S., (2000). The mixed bipolar disorders. In Bipolar Disorders–100 Years after Manic Depressive Insanity, ed. Marneros, A., and Angst, J., pp. 63–88. Dordrecht: Kluwer Academic Publishers.
Meltzer, H. L. (1986). Lithium mechanisms in bipolar illness and altered intracellular calcium functions. Biol. Psychiatry, 21, 492–510.Google Scholar
Meltzer, H. Y., and Lowy, M. T. (1987). The serotonin hypothesis of depression. In Psychopharmacology: The Third Generation of Progress, ed. Meltzer, H. Y., pp. 513–26. New York: Raven Press.
Moscovich, D. G., Belmaker, R. H., Agam, G., and Livne, A., (1990). Inositol-1-phosphatase in red blood cells of manic-depressive patients before and during treatment with lithium. Biol. Psychiatry, 27, 552–5.CrossRefGoogle Scholar
Pazzaglia, P. J., Post, R. M., Ketter, T. A., et al. (1993). Preliminary controlled trial of nimodipine in ultra-rapid cycling affective dysregulation. Psychiatry Res., 49, 257–72.CrossRefGoogle Scholar
Pazzaglia, P., Post, R. M., Ketter, T. A., et al. (1998). Nimodipine monotherapy and carbamazepine augmentation in patients with refractory recurrent affective illness. J. Clin. Psychopharmacol., 18, 404–13.Google Scholar
Perugi, G., Akiskal, H. S., Micheli, C., et al. (1997). Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases. J. Affect. Disord., 43, 169–80.CrossRefGoogle Scholar
Post, R. M., Rubinow, D. R., Uhde, T. W., et al. (1989). Dysphoric mania. Clinical and biological correlates. Arch. Gen. Psychiatry, 46, 353–8.CrossRefGoogle Scholar
Sachs, G. S., Grossman, F., Ghaemi, S. N., et al. (2002). Combination of a mood stabilizer with risperidone or haloperidol for treatment of acute mania: a double-blind, placebo-controlled comparison of efficacy and safety. Am. J. Psychiatry, 159, 1146–54.CrossRefGoogle Scholar
Sack, D. A., James, S. P., Rosenthal, N. E., and Wehr, T. A., (1988). Deficient nocturnal surge of TSH secretion during sleep and sleep deprivation in rapid-cycling bipolar illness. Psychiatry Res., 23, 179–91.CrossRefGoogle Scholar
Shimizu, E., Kodama, K., Sakamoto, T., et al. (1997). Recovery from neuroendocrinological abnormalities and frontal hypoperfusion after remission in a case with rapid cycling bipolar disorder. Psychiatry Clin. Neurosci., 51, 207–12.CrossRefGoogle Scholar
Swann, A. C., Stokes, P. E., Casper, R., et al. (1992). Hypothalamic–pituitary–adrenocortical function in mixed and pure mania. Acta Psychiatr. Scand. 85, 270–4.CrossRefGoogle Scholar
Swann, A. C., Stokes, P. E., Secunda, S. K., et al. (1994). Depressive mania versus agitated depression: biogenic amine and hypothalamic–pituitary–adrenocortical function. Biol. Psychiatry, 35, 803–13.CrossRefGoogle Scholar
Swann, A. C., Bowden, C. L., Morris, D., et al. (1997). Depression during mania. Treatment response to lithium or divalproex. Arch. Gen. Psychiatry, 54, 37–42.CrossRefGoogle Scholar
Tandon, R., Channabasavanna, S. M., and Greden, J. F. (1988). CSF biochemical correlates of mixed affective states. Acta Psychiatr. Scand., 78, 289–97.CrossRefGoogle Scholar
Tohen, M., Chengappa, K. N., Suppes, T., et al. (2002). Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy. Arch. Gen. Psychiatry, 59, 62–9.CrossRefGoogle Scholar
Vaden, D. L., Ding, D., Peterson, B., and Greenberg, M. L., (2001). Lithium and valproate decrease inositol mass and increase expression of the yeast ino1 and ino2 genes for inositol biosynthesis. J. Biol. Chem., 276, 15 466–71.Google Scholar
Walden, J., Grunze, H., Bingmann, D., et al. (1992). Calcium antagonistic effects of carbamazepine as a mechanism of action in neuropsychiatric disorders: studies in calcium dependent model epilepsies. Eur. Neuropsychopharmacol., 2, 455–62.CrossRefGoogle Scholar
Waldman, I. D., Robinson, B. F., and Feigon, S. A., (1997). Linkage disequilibrium between the dopamine transporter gene (DAT1) and bipolar disorder: extending the transmission disequilibrium test (TDT) to examine genetic heterogeneity. Genet. Epidemiol., 14, 699–704.3.0.CO;2-K>CrossRefGoogle Scholar
Wang, J. F., Bown, C. D., Chen, B., and Young, L. T., (2001). Identification of mood stabilizer-regulated genes by differential-display PCR. Int. J. Neuropsychopharmacol., 4, 65–74.CrossRefGoogle Scholar
Wegerer, J. V., Hesslinger, B., Berger, M. and Walden, J. (1997). A calcium antagonistic effect of the new antiepileptic drug lamotrigine. Eur. Neuropsychopharmacol., 7, 77–81.CrossRefGoogle Scholar
Werstiuk, E. S., Steiner, M. and Burns, T., (1990). Studies on leukocyte beta-adrenergic receptors in depression: a critical appraisal. Life Sci., 47, 85–105.CrossRefGoogle Scholar
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.
Xie, X. and Hagan, R. M., (1998). Cellular and molecular actions of lamotrigine: possible mechanisms of efficacy in bipolar disorder. Neuropsychobiology, 38, 119–30.CrossRefGoogle Scholar
Yatham, L. N., Liddle, P. F., Shia, I., et al. (2001). Presynaptic dopamine function in first episode neuroleptic and mood stabilizer naive non-psychotic mania and effects of treatment with divalproex sodium. A PET study. Bipolar Disord., 3, 62.Google Scholar
Zarate, C. A., Tohen, M., and Zarate, S. B., (1997). Thyroid function tests in first-episode bipolar disorder manic and mixed types. Biol. Psychiatry, 42, 302–4.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×