Risk factors of cycle acceleration in acutely admitted patients with bipolar disorder

ObjectiveTo identify risk factors associated with cycle acceleration (CA), that is, progressive decrease in duration of syndrome-free intervals between affective episodes, in acutely admitted patients with bipolar disorder (BD). MethodAll patients (n=210) with BD I (67%) and BD II (33%) (DSM-IV) acutely admitted to a hospital serving a catchment area were compared in retrospect with regard to a positive or negative history of CA. Putative risk factors of CA with a P-value <0.05 in uni-variate tests were secondly entered into a logistic regression model. ResultsThe logistic regression model was statistically significant (P<0.0001) and explained between 45.3% and 60.5% of the variance of CA status. 83.7% of the cases were correctly classified with a sensitivity of 87.2% and a specificity of 80.4%. Unique significant risk factors of CA were increasing severity of affective episodes (odds ratio (OR)=28.8), BD II (OR=3.3), hypomanic/manic episode induced by an antidepressant and/or alcohol (OR=3.3), and female gender (OR=3.1). ConclusionThe clinical factors associated with CA may help targeting patients with BD with a course aggravation, and are in line with previously reported neuropathological processes of illness progression.