From: mdkline@rodan.acs.syr.edu (Mark D. Kline)
Subject: Re: What is "bipolar rapid cyclic disorder"?
Organization: Syracuse University
Date: Fri, 4 Sep 92 18:24:14 EDT

In article <PARKES.92Sep3020550@re.itp.ethz.ch> parkes@itp.ethz.ch (Andrew Parkes) writes:
>The subject line says most of what I would like to know.  [ what is
>bipolar rapid cyclic disorder ] But, I also have more specific questions 
>such as:-

>Taking it literally I suppose the disorder just means quickly oscillating
>from one end of the emotional spectrum to the other (this sounds kind of
>familiar :-) ). But this interpretation seems to me (I'm not a psychologist)
>just like manic depression, so what are the distinguishing signs?
>Is anything known about what causes it?
> Also, I'm told that there are three chemical treatments used  
>Tegretol.   (sp?) Valproic Acid    (sp?) Lithium
>Does anyone have any experience with these?  Are they worth the side-effects?

Bipolar disorder (manic depressive illness) is a mood disorder
characterized by liability to episodes of depression and mania.
The disorder is diagnosed according to specific criteria which
are spelled out in the Diagnostic and Statistical Manual of
Mental Disorders, third edition revised (DSM III-R). A person
is said to be a "rapid cycler" or have "rapid cycling bipolar disorder" 
when they have more then three episodes of illness per year.
Unfortunately, frequent mood episodes ("rapid cycling") may
suggest a poorer prognosis.   

Generally, depressions or manic episodes last weeks to months.
Usually but not always, individuals who have very rapidly fluctuating
moods (i.e., changing from minute to minute, or during the course of a
single day) are suffering from something other than bipolar disorder,
usually a character disorder associated with unstable mood.  Bipolar
disorder is a heritable condition; in most but not all cases, there is
a family history either of bipolar or other mood disorder or
alcoholism.   The definitive technical book on bipolar disorder is
_Manic_Depressive_Illness by FK Goodwin and R. Jamison. 
Valuable and reasonably up to date information on MDI can be found
in Nancy Andreasen's book for laypeople, _The_Broken_Brain:_The
Biological_Revolution_in_Psychiatry.  Most authorities now believe
that manic depressive illness is associated with alterations in
the function of catecholamine and indoleamine neurotransmitters 
(norepinephrine, dopamine, and serotonin).  People with bipolar
illness are generally (not always) smarter and more creative
than other people:  their ranks include Hemmingway,  Plath
and Abbie Hoffman (who all died by suicide, a major risk) and
perhaps also Winston Churchill and Abraham Lincoln.

Lithium is the mainstay of treatment nowadays for MDI: Li treats
mania acutely, prevents mania and depression, and also has 
antidepressant effects.  Many patients do require treatment with
other psychotropic agents during the course of their illness (e.g.,
lithium may prevent mania but patients may still have breakthrough
depression).   Tegretol and Valproate are anticonvulsant drugs
which also have mood stabilizing properties and are becoming
more widely used.   The side effects of these drugs are definitely
worthwhile when skillfully prescribed and properly taken. 
Li can cause tremor, GI disturbances (nausea, diarrhea), increased
urination, and a funny metalic taste in the mouth; Li can 
slow the thyroid and in excessive doses or when the level in the 
body is too high, lithium can damage the kidneys and cause neurologic
damage; the level must be monitored and the dose properly individualized.
The Lithium information center at the University of Wisconsin puts
out an excellent patient education pamphlet on Lithium and Manic
Depressive illness.  

Hope this is a helpful beginning.

- Mark Kline, MD
--
================================================================= 
mark kline                              mdkline@rodan.acs.syr.edu
suny health science center, syracuse    voice: (315) 422-1050
================ courtesy of syracuse university ================
Newsgroups: sci.psychology