The British Journal of Psychiatry (2009) 195: 525-530. doi: 10.1192/bjp.bp.108.062083
© 2009 The Royal College of Psychiatrists
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Empirical typology of bipolar I mood episodes*

David A. Solomon, MD

Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, and UpToDate Inc., Waltham, Massachusetts

Andrew C. Leon, PhD

Department of Psychiatry, Weill Cornell Medical College, New York

Jean Endicott, PhD

New York State Psychiatric Institute, New York

William H. Coryell, MD

Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa

Chunshan Li, MA

Department of Psychiatry, Weill Cornell Medical College, New York

Jess G. Fiedorowicz, MD, MS

Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa

Martin B. Keller, MD

Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

Correspondence: Correspondence: David A. Solomon, MD, Mood Disorders Program, Department of Psychiatry, Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island, 02903-4970, USA. Email: DASolomon{at}Lifespan.org

Declaration of interest

D.A.S. has served as investigator for research funded by the US National Institute of Mental Health (NIMH), the US National Institute of Neurological Disorders and Stroke, Janssen Pharmaceutica, Wyeth-Ayerst Laboratories, and Merck; as consultant to Solvay Pharmaceuticals, Shire and Novartis; and on the lecture bureaux of AstraZeneca, Pfizer, GlaxoSmithKline, and Shire. A.C.L. has served as investigator for research funded by NIMH and the US National Institute of Drug Abuse, served on data safety monitoring boards for AstraZeneca, Dainippon Sumitomo Phrama (America), and Pfizer; and as consultant to the U.S. Food and Drug Administration, NIMH, Cyberonics, and MedAvante (equity). J.E. has been an investigator for research funded by four of the US National Institutes of Health and the New York State Department of Mental Health, received research support from Abbott, Bristol-Meyers Squibb, Cyberonics, Interneuron, Merck, Parke-Davis, Pfizer, Upjohn, and Wyeth-Ayerst, and served as consultant/advisory board member for Abbott, AstraZeneca, Berlex, Bristol-Meyers Squibb, Cyberonics, Eli Lilly, GlaxoSmithKline, Novartis, Otsuka, Janssen, Ovation, Pfizer, Sanofi-Synthelabo, and Wyeth-Ayerst. M.B.K. has served as consultant or received honoraria from Abbott, Cenerex, Cephalon, Cypress Bioscience, Cyberonics, Forest Laboratories, Janssen, JDS, Medtronic, Organon, Novartis, Pfizer, Roche, Solvay, and Wyeth Pharmaceuticals; received research support from Pfizer; and served on advisory boards for Abbott Laboratories, Bristol-Myers Squibb, Cenerex, Cyberonics, Cypress Bioscience, Forest Laboratories, Janssen, Novartis, Organon, and Pfizer.

* Presented in part at the American Psychiatric Association, 161st Annual Meeting, Washington DC, 6 May 2008.

Background

Much remains unknown about the phenomenology of bipolar I disorder.

Aims

To determine the type of bipolar I mood episodes that occur over time, and their relative frequency.

Method

A total of 219 individuals with Research Diagnostic Criteria bipolar I disorder were prospectively followed for up to 25 years (median 20 years). Psychopathology was assessed with the Longitudinal Interval Follow-up Evaluation.

Results

Overall, 1208 mood episodes were prospectively observed. The episodes were empirically classified as follows: major depression, 30.9% (n = 373); minor depression, 13.0% (n = 157); mania, 20.4% (n = 246); hypomania, 10.4% (n = 126); cycling, 17.3% (n = 210); cycling plus mixed state, 7.8% (n = 94); and mixed, 0.2% (n = 2).

Conclusions

Cycling episodes constituted 25% of all episodes. Work groups revising ICD–10 and DSM–IV should add a category for bipolar I cycling episode.


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D. A. Solomon, A. C. Leon, W. H. Coryell, J. Endicott, C. Li, J. G. Fiedorowicz, L. Boyken, and M. B. Keller
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Arch Gen Psychiatry, April 1, 2010; 67(4): 339 - 347.
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