Research report Suicide risk in rapid cycling bipolar patients Margarita Garcia-Amador ⁎, Francesc Colom, Marc Valenti, Guillermo Horga, Eduard Vieta Hospital Clinic, University of Barcelona, IDIBAPS; C/Villarroel 140; 08036, Barcelona, Spain article info abstract Article history: Received 28 April 2008 Received in revised form 5 December 2008 Accepted 5 December 2008 Available online 1 January 2009 Background: Rapid-cycling (RC) is a course modifier of bipolar disorder which often implicates a poor prognosis. However, the relationship of RC with suicidal features as a marker of impairment has been understudied. Methods: Three hundred and five patients (n = 305) were included in a naturalistic, systematic prospective study in a single site setting. Patients with rapid-cycling (RC) were defined as having four or more manic, mixed or depressive episodes in the year prior to baseline assessment. The two groups were compared regarding clinical and sociodemographic variables, paying special attention to suicidal features. Statistical methods consisted of chi-square statistic for the comparison of categorical data, and Student's t test for dimensional variables normally distributed. Also, a General Linear Model was used to study the main effect of different sociodemographic and clinical variables on suicidality. All statistics were two-tailed, and significance was set at p less than 0.05. Results: Fifty-five patients (18%) were classified as RC, whilst 250 (82%) were considered as nonrapid-cycling (NRC). No significative difference was found in the prevalence of RC amongst bipolar I and II patients. RC was associated with depressive onset of bipolar disorder. The number of suicide attempts was significantly higher amongst RC (RC mean 0.82 [SD 1.85] vs. NRC 0.44[SD 0.94] t = 2.09, p = 0.37). Nonetheless, no significative differences were found between RC and NRC regarding the percentage of suicide attempters. On the other hand patients that presented RC showed a marked increase of lifetime history of suicidal ideation (Chi 2 = 4.363, p =0.039). Finally, there were not any differences between RC patients and NRC in family history of suicide. Discussion: Bipolar patients with RC are more likely to attempt suicide. Intensive treatment of this marker should be considered. © 2008 Elsevier B.V. All rights reserved. Keywords: Rapid-cycling Suicide 1. Introduction Rapid-cycling (RC) is a condition that may mark a difference in bipolar disorder prognosis This condition was first described in 1974 by Dunner and Fieve (Dunner and Fieve, 1974) as patients presenting four or more manic or depressive episodes during at least 2 weeks. More recently, DSM-IV has defined RC as a course modifier (Association, 1994). This definition has been confirmed by other authors (Bauer and Whybrow, 1996)(Kilzieh and Akiskal, 1999). The frequency of RC in bipolar population has been reported as 20% in patients diagnosed with bipolar disorder (Dunner and Fieve, 1974)(Baldessarini et al., 2000; Koukopoulos et al., 2003; Maj et al., 1994, 1999; Schneck et al., 2004). Rapid cycling condition predicts a minor likelihood to achieve remission after index affective episode (Coryell et al., 1993), greater number of lifetime affective episodes, poorer response to lithium and other pharmacologic agents and, hence, a poorer prognosis than NRC. Suicidality is one of the most dangerous complications in affective disorders (Rihmer, 2007). Several factors could raise the risk of suicidal attempts in RC patients. In fact, The FDA (Food and Drug Administration) (FDA, 2006a, b) has pointed Journal of Affective Disorders 117 (2009) 74–78 ⁎ Corresponding author. E-mail addresses: margaritagarciaamador@yahoo.es (M. Garcia-Amador), fcolom@clinic.ub.es (F. Colom), marcvalenti@hotmail.com (M. Valenti), guillehohe@yahoo.com (G. Horga), evieta@clinic.ub.es (E. Vieta). 0165-0327/$ – see front matter © 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2008.12.005 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad