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Rapid Cycling Bipolar Affective Disorder: I. Association With Grade I Hypothyroidism

Rapid Cycling Bipolar Affective Disorder: I. Association With Grade I Hypothyroidism Abstract • Thirty patients with rapid cycling bipolar affective disorder were studied prospectively to assess presence and severity of thyroid hypofunction. Seven (23%) were classified as having grade I hypothyroidism, while 8 (27%) had grade II and 3 (10%) had grade III abnormalities. This prevalence of grade I hypothyroidism is significantly greater than that reported in studies of unselected bipolar patients during long-term treatment with lithium carbonate, although only 63% of this sample of rapid cycling patients was taking lithium carbonate or carbamazepine. The association of rapid cycling with grade I hypothyroidism cannot be accounted for by lithium carbonate use or by the preponderance of women among rapid cycling patients. These findings (1) indicate that hypothyroidism during bipolar illness is a risk factor for the development of rapid cycling, and (2) leads to the hypothesis that a relative central thyroid hormone deficit occurring in bipolar patients predisposes to a rapid cycling course. References 1. Dunner D, Fieve R. Clinical factors in lithium carbonate prophylaxis failure . Arch Gen Psychiatry . 1974;30:229-233.Crossref 2. Cho J, Bone S, Dunner D, Colt E, Fieve R. The effect of lithium treatment on thyroid function in patients with primary affective disorder . Am J Psychiatry . 1979;136:115-116. 3. Cowdry R, Wehr T, Zis A, Goodwin F. Thyroid abnormalities associated with rapid cycling bipolar illness . Arch Gen Psychiatry . 1983;40:414-420.Crossref 4. Wehr T, Sack D, Rosenthal N, Cowdry R. Rapid cycling affective disorder: contributing factors and treatment responses in 51 patients . Am J Psychiatry . 1988;145:179-184. 5. Joffe R, Kutcher S, MacDonald C. Thyroid function and bipolar affective disorder . Psychiatry Res . 1987;21:117-121. 6. Amsterdam J, Winokur A, Lucki I, et al. A neuroendocrine test battery in bipolar patients and healthy subjects . Arch Gen Psychiatry . 1983;40:515-521.Crossref 7. Weissman M, Boyd J. The epidemiology of affective disorders . In: Post R, Ballenger J, eds. Neurobiology of Mood Disorders . Baltimore, Md: Williams & Wilkins; 1985:60-75. 8. Tunbridge W, Evered D, Hall R, Appleton D, Brewis M, Clark F, Evans J, Young E, Bird T, Smith P. The spectrum of thyroid disease in a community: the Whickham Survey . Clin Endocrinol . 1977;7:481-493.Crossref 9. Emerson C, Dyson W, Utiger R. Serum thyrotropin and thyroxine concentrations in patients receiving lithium carbonate . J Clin Endocrinol Metab . 1973;36:338-346.Crossref 10. McLarty D, O'Boyle J, Spencer C, Ratcliffe J. Effect of lithium on hypothalamic-pituitary-thyroid function in patients with affective disorders . Br Med J . 1975;2:623-626.Crossref 11. Linstedt G, Nilsson L-A, Walinder J, Skott A, Ohman R. On the prevalence, diagnosis and management of lithium-induced hypothyroidism in psychiatric patients . Br J Psychiatry . 1977;130:452-458.Crossref 12. Transbol I, Christiansen C, Baestrup P. Endocrine effects of lithium, I: hypothyroidism, its prevalence in long-term treated patients . Acta Endocrinol . 1978;87:759-767. 13. Lazarus J, John R, Bennie E, Chalmers R, Crockett G. Lithium therapy and thyroid function: a long-term study . Psychol Med . 1981;11:85-92.Crossref 14. Copolov D, Rubin R. Endocrine disturbances in affective disorders and schizophrenia . In: Nemeroff C, Loosen P, eds. Handbook of Clinical Psychoneuroendocrinology . New York, NY: Guilford Press; 1987:160-194. 15. Spitzer R, Endicott J, Robins E. Research Diagnostic Criteria for a Selected Group of Functional Disorders . 3rd ed. New York, NY: New York State Psychiatric Institute; 1978. 16. Endicott J, Spitzer R. A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry . 1978;35:837-844.Crossref 17. Hamilton M. A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;23:56-62.Crossref 18. Young R, Biggs J, Meyer D. A rating scale for mania: reliability, validity, and sensitivity . Br J Psychiatry . 1978;133:429-435.Crossref 19. Nunally J. Psychometric Theory . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1978. 20. Bauer M, Whybrow P. The effect of changing thyroid function on cyclic affective illness in a human subject . Am J Psychiatry . 1986;143:633-636. 21. Bauer M, Whybrow P. Rapid cycling bipolar affective disorder, II: treatment of refractory rapid cycling with high-dose levothyroxine: a preliminary study . Arch Gen Psychiatry . 1990;47:435-440.Crossref 22. Wenzel K, Meinhold H, Raffenberg M, Adlkofer F, Schleusener H. Classification of hypothyroidism in evaluating patients after radioiodine therapy by serum cholesterol, T3-uptake, total T4, FT4-index, total T3, basal TSH, and TRH test . Eur J Clin Invest . 1974;4:141-148. 23. Bauer M, Caroff S, Winokur A, Koenig R. Neuroendocrine responses of cold stress in normal subjects and depressives . Psychoneuroendocrinology . 1987;12:483-490.Crossref 24. Schlesselman J. Case Control Studies: Design, Method, Analysis . New York, NY: Oxford University Press; 1985. 25. Brown M. Frequency tables (P4F) . In: Dixon W, ed. BMDP Statistical Software . Berkeley, Calif: University of California Press; 1985;2:229-308. 26. Dunner D, Patrick V, Fieve R. Rapid cycling manic depressive patients . Compr Psychiatry . 1977;18:561-566.Crossref 27. Bunney W, Hartmann E. Study of a patient with 48 hour manic-depressive cycles . Arch Gen Psychiatry . 1965;12:611-618.Crossref 28. Jenner F, Gjessing L, Cox J, Davies-Jones A, Hullin R, Hanna S. A manic-depressive psychotic with a persistent forty-eight hour cycle . Br J Psychiatry . 1967;113:895-910.Crossref 29. Bauer M, Droba M, Whybrow P. Disorders of the thyroid and parathyroid . In: Nemeroff C, Loosen P, eds. Handbook of Clinical Psychoneuroendocrinology . New York, NY: Guilford Press; 1987:41-70. 30. Bauer M, Whybrow P. Rapid cycling bipolar disorder: clinical features, treatment, and etiology . In: Amsterdam J, ed. Refrectory Depression—Frontiers in Research and Treatment . New York, NY: Raven Press. In press. 31. Dratman M, Crutchfield F, Gordon J, Jennings A. Iodothyronine homeostasis in rat brain during hypo- and hyperthyroidism . Am J Physiol . 1983;245:R185-R193. 32. St Germain D. Regulatory effect of lithium on thyroxine metabolism in murine neural and anterior pituitary tissue . Endocrinology . 1987;120:1430-1438.Crossref 33. Dratman M, Crutchfield F. Thyroid hormones and adrenergic neurotransmitters in the brain. In: Usdin E, Kopin I, eds. Catecholamines Basic and Clinical, Fourth International Catecholamine Symposium. Elmsford, NY: Pergamon Press Inc; 1978:1155-1157. 34. Stancer H, Persad E. Treatment of intractable rapid-cycling manicdepressive disorder with levothyroxine: clinical observations . Arch Gen Psychiatry . 1982;39:311-312.Crossref 35. Gold M, Pottash A, Muller E, Extein I. Grades of thyroid failure in depressed and anergic psychiatric inpatients . Am J Psychiatry . 1981;138:253-255. 36. Prange A, Loosen P, Wilson I, Lipton M. The therapeutic use of hormones of the thyroid axis in depression . In: Post R, Ballenger J, eds. Neurobiology of Mood Disorders . Baltimore, Md: Williams & Wilkins; 1980:311-322. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Rapid Cycling Bipolar Affective Disorder: I. Association With Grade I Hypothyroidism

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1990.01810170027005
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Abstract

Abstract • Thirty patients with rapid cycling bipolar affective disorder were studied prospectively to assess presence and severity of thyroid hypofunction. Seven (23%) were classified as having grade I hypothyroidism, while 8 (27%) had grade II and 3 (10%) had grade III abnormalities. This prevalence of grade I hypothyroidism is significantly greater than that reported in studies of unselected bipolar patients during long-term treatment with lithium carbonate, although only 63% of this sample of rapid cycling patients was taking lithium carbonate or carbamazepine. The association of rapid cycling with grade I hypothyroidism cannot be accounted for by lithium carbonate use or by the preponderance of women among rapid cycling patients. These findings (1) indicate that hypothyroidism during bipolar illness is a risk factor for the development of rapid cycling, and (2) leads to the hypothesis that a relative central thyroid hormone deficit occurring in bipolar patients predisposes to a rapid cycling course. References 1. Dunner D, Fieve R. Clinical factors in lithium carbonate prophylaxis failure . Arch Gen Psychiatry . 1974;30:229-233.Crossref 2. Cho J, Bone S, Dunner D, Colt E, Fieve R. The effect of lithium treatment on thyroid function in patients with primary affective disorder . Am J Psychiatry . 1979;136:115-116. 3. Cowdry R, Wehr T, Zis A, Goodwin F. Thyroid abnormalities associated with rapid cycling bipolar illness . Arch Gen Psychiatry . 1983;40:414-420.Crossref 4. Wehr T, Sack D, Rosenthal N, Cowdry R. Rapid cycling affective disorder: contributing factors and treatment responses in 51 patients . Am J Psychiatry . 1988;145:179-184. 5. Joffe R, Kutcher S, MacDonald C. Thyroid function and bipolar affective disorder . Psychiatry Res . 1987;21:117-121. 6. Amsterdam J, Winokur A, Lucki I, et al. A neuroendocrine test battery in bipolar patients and healthy subjects . Arch Gen Psychiatry . 1983;40:515-521.Crossref 7. Weissman M, Boyd J. The epidemiology of affective disorders . In: Post R, Ballenger J, eds. Neurobiology of Mood Disorders . Baltimore, Md: Williams & Wilkins; 1985:60-75. 8. Tunbridge W, Evered D, Hall R, Appleton D, Brewis M, Clark F, Evans J, Young E, Bird T, Smith P. The spectrum of thyroid disease in a community: the Whickham Survey . Clin Endocrinol . 1977;7:481-493.Crossref 9. Emerson C, Dyson W, Utiger R. Serum thyrotropin and thyroxine concentrations in patients receiving lithium carbonate . J Clin Endocrinol Metab . 1973;36:338-346.Crossref 10. McLarty D, O'Boyle J, Spencer C, Ratcliffe J. Effect of lithium on hypothalamic-pituitary-thyroid function in patients with affective disorders . Br Med J . 1975;2:623-626.Crossref 11. Linstedt G, Nilsson L-A, Walinder J, Skott A, Ohman R. On the prevalence, diagnosis and management of lithium-induced hypothyroidism in psychiatric patients . Br J Psychiatry . 1977;130:452-458.Crossref 12. Transbol I, Christiansen C, Baestrup P. Endocrine effects of lithium, I: hypothyroidism, its prevalence in long-term treated patients . Acta Endocrinol . 1978;87:759-767. 13. Lazarus J, John R, Bennie E, Chalmers R, Crockett G. Lithium therapy and thyroid function: a long-term study . Psychol Med . 1981;11:85-92.Crossref 14. Copolov D, Rubin R. Endocrine disturbances in affective disorders and schizophrenia . In: Nemeroff C, Loosen P, eds. Handbook of Clinical Psychoneuroendocrinology . New York, NY: Guilford Press; 1987:160-194. 15. Spitzer R, Endicott J, Robins E. Research Diagnostic Criteria for a Selected Group of Functional Disorders . 3rd ed. New York, NY: New York State Psychiatric Institute; 1978. 16. Endicott J, Spitzer R. A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry . 1978;35:837-844.Crossref 17. Hamilton M. A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;23:56-62.Crossref 18. Young R, Biggs J, Meyer D. A rating scale for mania: reliability, validity, and sensitivity . Br J Psychiatry . 1978;133:429-435.Crossref 19. Nunally J. Psychometric Theory . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1978. 20. Bauer M, Whybrow P. The effect of changing thyroid function on cyclic affective illness in a human subject . Am J Psychiatry . 1986;143:633-636. 21. Bauer M, Whybrow P. Rapid cycling bipolar affective disorder, II: treatment of refractory rapid cycling with high-dose levothyroxine: a preliminary study . Arch Gen Psychiatry . 1990;47:435-440.Crossref 22. Wenzel K, Meinhold H, Raffenberg M, Adlkofer F, Schleusener H. Classification of hypothyroidism in evaluating patients after radioiodine therapy by serum cholesterol, T3-uptake, total T4, FT4-index, total T3, basal TSH, and TRH test . Eur J Clin Invest . 1974;4:141-148. 23. Bauer M, Caroff S, Winokur A, Koenig R. Neuroendocrine responses of cold stress in normal subjects and depressives . Psychoneuroendocrinology . 1987;12:483-490.Crossref 24. Schlesselman J. Case Control Studies: Design, Method, Analysis . New York, NY: Oxford University Press; 1985. 25. Brown M. Frequency tables (P4F) . In: Dixon W, ed. BMDP Statistical Software . Berkeley, Calif: University of California Press; 1985;2:229-308. 26. Dunner D, Patrick V, Fieve R. Rapid cycling manic depressive patients . Compr Psychiatry . 1977;18:561-566.Crossref 27. Bunney W, Hartmann E. Study of a patient with 48 hour manic-depressive cycles . Arch Gen Psychiatry . 1965;12:611-618.Crossref 28. Jenner F, Gjessing L, Cox J, Davies-Jones A, Hullin R, Hanna S. A manic-depressive psychotic with a persistent forty-eight hour cycle . Br J Psychiatry . 1967;113:895-910.Crossref 29. Bauer M, Droba M, Whybrow P. Disorders of the thyroid and parathyroid . In: Nemeroff C, Loosen P, eds. Handbook of Clinical Psychoneuroendocrinology . New York, NY: Guilford Press; 1987:41-70. 30. Bauer M, Whybrow P. Rapid cycling bipolar disorder: clinical features, treatment, and etiology . In: Amsterdam J, ed. Refrectory Depression—Frontiers in Research and Treatment . New York, NY: Raven Press. In press. 31. Dratman M, Crutchfield F, Gordon J, Jennings A. Iodothyronine homeostasis in rat brain during hypo- and hyperthyroidism . Am J Physiol . 1983;245:R185-R193. 32. St Germain D. Regulatory effect of lithium on thyroxine metabolism in murine neural and anterior pituitary tissue . Endocrinology . 1987;120:1430-1438.Crossref 33. Dratman M, Crutchfield F. Thyroid hormones and adrenergic neurotransmitters in the brain. In: Usdin E, Kopin I, eds. Catecholamines Basic and Clinical, Fourth International Catecholamine Symposium. Elmsford, NY: Pergamon Press Inc; 1978:1155-1157. 34. Stancer H, Persad E. Treatment of intractable rapid-cycling manicdepressive disorder with levothyroxine: clinical observations . Arch Gen Psychiatry . 1982;39:311-312.Crossref 35. Gold M, Pottash A, Muller E, Extein I. Grades of thyroid failure in depressed and anergic psychiatric inpatients . Am J Psychiatry . 1981;138:253-255. 36. Prange A, Loosen P, Wilson I, Lipton M. The therapeutic use of hormones of the thyroid axis in depression . In: Post R, Ballenger J, eds. Neurobiology of Mood Disorders . Baltimore, Md: Williams & Wilkins; 1980:311-322.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: May 1, 1990

References