The DSM-IV-TR defines rapid cycling as four discrete episodes of mania or depression occurring within 1 year. However, the actual appearance of rapid cycling in bipolar disorder can be quite varied, and research surrounding rapid cycling (including research focusing on suicidality) remains inconsistent. While the prevalence of rapid cycling in bipolar disorder is unclear and may be difficult to diagnose, it appears that its identification is necessary for effective suicide prevention.
In a sample of 603 bipolar individuals, MacKinnon et al. (2003) found patients with rapid cycling to be significantly more likely than non-rapid cyclers to have attempted suicide (42% vs. 27% respectively). Coryell et al. (2003) also found rapid-cycling bipolar disorder to be associated with more serious suicide attempts, although it was not associated with a greater number of completed suicides. Thus, there appears to be a significant additional burden on the patient as a result of the rapid cycling that increases vulnerability to suicidality. This potential susceptibility may rest in an underlying aspect of rapid-cycling bipolar disorder that leads to a generally more complicated illness course. As an example, we may consider MacKinnon et al.'s (2003) case-controlled examination, which found rapid cycling to be associated with an earlier age at onset, higher psychiatric comorbidity, more substance and alcohol abuse, and suicidality.
Whereas the previously mentioned studies demonstrate an added risk, others, such as that of Wu and Dunner (1993), did not find a higher rate of suicide in rapid cyclers when compared to non-rapid cyclers. Slama et al. (2004) also failed to find an association between rapid cycling and suicide attempts in a French sample. However, inconsistency in suicide research is likely to be a result of the difficulties of defining and identifying rapid cycling in both research and clinical practice: because of the variety of measures and primary hypotheses of the previously mentioned studies, operational definitions and measurements of rapid cycling may vary. One result of this may be the misinterpretation of a distinct mixed episode as a presentation of rapid cycling. Consequently, as with almost all factors researched with respect to rapid cycling, the impact of rapid cycling on suicidality is not eminently clear. Nevertheless, it appears that whether or not it has a direct impact on suicidality, rapid cycling is a more complicated manifestation of bipolar disorder and requires formidable clinical management for the prophylaxis of suicidality.
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