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Biomedical subjects

Christopher D Schneck

Publications and source records attributed to Christopher D Schneck.

3 recordsLinked to original sources
PubMed2006

Treatment of rapid-cycling bipolar disorder.

Rapid-cycling bipolar disorder is associated with poorer treatment response, poorer long-term prognosis, and probable higher suicide risk than bipolar disorder without rapid cycling. Patients with rapid cycling tend to experience more depressive than manic episodes, and the depressive episodes tend to be more refractory in nature compared with those in patients without rapid cycling. Results from studies of rapid cycling show that antidepressant use is most likely associated with the onset or worsening of rapid cycling. Controversy also exists as to whether rapid cycling is a transitory phenomenon in the course of bipolar illness or a more chronic condition better characterized as a subtype of the illness. Results from the first 500 patients with bipolar I or bipolar II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study found an association between rapid cycling and depression and younger age at illness onset. Treatment involves a 3-part pathway to manage rapid cycling that includes reducing or stopping any possible cycle-promoting agents, adding or optimizing mood stabilizers, and using experimental or putative treatments for persistent rapid cycling after more traditional treatments have failed. Effective treatments for some patients with rapid-cycling bipolar disorder currently include lithium, divalproex, lamotrigine, carbamazepine, atypical antipsychotics, and psychosocial therapy.

Age of Onset↗
PubMed2004

Phenomenology of rapid-cycling bipolar disorder: data from the first 500 participants in the Systematic Treatment Enhancement Program.

OBJECTIVE: This study compared demographic and phenomenological variables between bipolar patients with and without rapid cycling as a function of bipolar I versus bipolar II status. METHOD: The authors examined demographic, historical, and symptomatic features of patients with and without rapid cycling in a cross-sectional study of the first 500 patients with bipolar I or bipolar II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder, a multicenter project funded by the National Institute of Mental Health designed to evaluate the longitudinal outcome of patients with bipolar disorder. RESULTS: Rapid-cycling bipolar disorder occurred in 20% of the study group. Rapid-cycling patients were more likely to be women, although the effect was somewhat more pronounced among bipolar I patients than bipolar II patients. In addition, rapid-cycling bipolar patients experienced onset of their illness at a younger age, were more often depressed at study entry, and had poorer global functioning in the year before study entry than nonrapid-cycling patients. Rapid-cycling patients also experienced a significantly greater number of depressive and hypomanic/manic episodes in the prior year. A lifetime history of psychosis did not distinguish between rapid and nonrapid-cycling patients, although bipolar I patients were more likely to have experienced psychosis than bipolar II patients. CONCLUSIONS: Patients with rapid-cycling bipolar disorder demonstrate a greater severity of illness than nonrapid-cycling patients on a number of clinical measures. This study highlights the need to refine treatments for rapid cycling to reduce the overall morbidity and mortality of patients with this illness course modifier.

Adult↗