Bipolar disorder with frequent mood episodes in the national comorbidity survey replication (NCS-R)

A. A. Nierenberg, H. S. Akiskal, J. Angst, R. M. Hirschfeld, K. R. Merikangas, M. Petukhova, R. C. Kessler

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Virtually nothing is known about the epidemiology of rapid cycling bipolar disorder (BPD) in community samples. Nationally representative data are reported here for the prevalence and correlates of a surrogate measure of DSM-IV rapid cycling BPD from the National Comorbidity survey Replication (NCS-R), a national survey of the US household population. DSM-IV disorders were assessed in the NCS-R with the WHO Composite International Diagnostic Interview (CIDI). Although the CIDI did not assess rapid cycling, it did assess the broader category of 12-month BPD with frequent mood episodes (FMEs), having at least four episodes of mania/hypomania or major depression in the 12 months before interview. Roughly one-third of NCS-R respondents with lifetime DSM-IV BPD and half with 12-month BPD met criteria for FME. FME was associated with younger age-of-onset (of BP-I, but not BP-II) and higher annual persistence (73% of the years since first onset of illness with an episode) than non-FME BPD. No substantial associations of FME vs non-FME BPD were found with socio-demographics, childhood risk factors (parental mental disorders, other childhood adversities) or comorbid DSM-IV disorders. However, FME manic episodes had greater clinical severity than non-FME episodes (assessed with a fully structured version of the Young Mania Rating Scale) and FME hypomanic episodes had greater role impairment than non-FME episodes (assessed with the Sheehan Disability Scales). Whether these indicators of severity merely reflect attenuated effects of rapid cycling or independent effects of sub-threshold rapid cycling warrants further study given the high proportion of lifetime cases who met criteria for FME.

Original languageEnglish (US)
Pages (from-to)1075-1087
Number of pages13
JournalMolecular Psychiatry
Issue number11
StatePublished - Nov 2010
Externally publishedYes


  • bipolar disorder
  • comorbidity
  • hypomania
  • mania
  • national comorbidity survey replication (NCS-R)
  • rapid-cycling bipolar disorder
  • treatment

ASJC Scopus subject areas

  • Molecular Biology
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience


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