Klinische Relevanz und Behandlungsmöglichkeiten von Rapid Cycling bei Patienten mit bipolarer affektiver Störung

Zusammenfassung

Nach den derzeit gültigen diagnostischen Leitlinien des ICD-10 finden Subtypen des bipolaren Spektrums syndromorientiert und in Bezug auf den Verlauf nur randständig Berücksichtigung. Im Gegensatz dazu hat im amerikanischen DSM-IV eine Unterteilung von Bipolar-I-Störung (ausgeprägte manische und depressive Episoden) und Bipolar-II-Störung (hypomanische und depressive Episoden) bereits 1994 Eingang gefunden. Auch wird eine differenzielle Verlaufsbeobachtung der Erkrankung mit klinischer Relevanz, wie das Rapid Cycling (RC), mit einbezogen. Dabei handelt es sich um einen Verlauf einer bipolaren Erkrankung mit mindestens 4 affektiven Episoden in einem Jahr. Für diesen wird ebenso wie bei gemischten Episoden und einem atypischen Beginn (initiale Depression) bei Patienten mit einer bipolaren Erkrankung ein schlechteres Ansprechen auf die Standardtherapie Lithium postuliert. Aufgrund dessen sind medikamentöse Alternativen und zusätzliche Therapieansätze hinsichtlich einer Phasenprophylaxe aus klinischer Sicht dringend notwendig; diese werden im Beitrag auf aktuellem Stand dargestellt und diskutiert. Ebenso werden mit RC assoziierte Parameter wie gehäuftes Auftreten bei Frauen, hypothyreote Stoffwechsellage, bipolarer Subtyp, COMT-Allel, Einfluss durch Schlaf und Induktion durch Antidepressiva dargestellt.

Abstract

In the actual version of the WHO diagnostic guidelines, the ICD-10, subtypes of bipolar disorder are not specified, in contrast to the American DSM-IV, where bipolar disorder has already been differentiated in bipolar I (severe manic and depressive episodes) and bipolar II disorder (depressive and hypomanic episodes). Furthermore, aspects of the longitudinal course of the illness, like rapid cycling (RC), are reflected as well. Rapid cycling is defined as four or more affective episodes within one year of the illness. It has been postulated that rapid cycling is related with a poor response to lithium, to the same extent as mixed episodes or an atypical onset (depressive episode first) of the disease. Here, the current status of alternative pharmacological and supportive therapy of rapid cycling is presented and discussed. Furthermore, the article also displays biological parameters associated with rapid cycling like higher prevalence in women, hypothyreoidism, subtype of bipolar disorder, COMT-allele, influence of sleep or risk of antidepressant induced cycling.

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