Obesity and obstetric complications are associated with rapid-cycling in Italian patients with bipolar disorder.

BACKGROUND: Rapid cycling (RC) worsens the course of bipolar disorder (BD) being associated with poor response to pharmacotherapy. Previous studies identified clinical variables potentially associated with RCBD: however, in many cases, results were discordant or unreplicated. The present study was aimed to compare clinical variables between RC and non RC bipolar patients and to identify related risk factors.

METHODS: A sample of 238 bipolar patients was enrolled from 3 different community mental health centers. Descriptive analyses were performed on total sample, and patients were compared in terms of socio-demographic and clinical variables according to the presence of RC by multivariate analyses of variance (MANOVAs, continuous variables) or χ2 tests (qualitative variables). Binary logistic regression was performed to calculate odds ratios.

RESULTS: Twenty-eight patients (11.8%) had RC. The two groups were not different in terms of age, age at onset, gender distribution, type of family history, type of substance use disorder, history of antidepressant therapy, main antidepressant, psychotic symptoms, comorbid anxiety disorders, suicide attempts, thyroid diseases, diabetes, type of BD, duration of untreated illness, illness duration, duration of antidepressant treatment and GAF scores. In contrast, RC patients had more often a history of obstetric complications (p<0.05), obesity (p<0.05) and a trend to hypercholesterolemia (p=0.08). In addition, RC bipolar patients presented more frequently lifetime MDMA misuse (p<0.05) than patients without RC.

DISCUSSION: Findings from the present study seem to indicate that obesity and obstetric complications are risk factors for the development of RC in BD. In addition, lifetime MDMA misuse may be more frequent in RC bipolar patients.