Factors associated with lifetime rapid cycling in bipolar disorder: Findings from the Bipolar Disorder Course and Outcome study from India (BiD-CoIN study)

Background: There is a lack of information about factors associated with Bipolar disorder (BD), Rapid Cycling (RC) course in the Indian context. Aim: This study aimed to evaluate the prevalence and factors associated with BD-RC course using data from the Bipolar Disorder Course and Outcome study from India (BiD-CoIN study). Methodology: This was a secondary analysis of data obtained from the BiD-CoIN study to evaluate the factors associated with RC in bipolar disorder. Results: Out of the 773 patients, about 6 % of BD patients have RC in their lifetime. Factors associated with RC included: being unemployed/homemakers (p < 0.001), being non-Hindus (p = 0.001), longer duration of episodes (p < 0.001), higher number of total and depressive episodes (in a lifetime, per year of illness, first five years, and per year of illness in first five years) (p < 0.001), higher number of manic, hypomanic, and mixed episodes (in the lifetime and per year of illness), shorter duration of current remission (p = 0.01), higher severity of depressive episodes in a lifetime, higher depressive affective morbidity index (p < 0.001), lower severity of manic episodes (p = 0.003), higher level of overall disability (p = 0.01) and in the interpersonal relationship domain, more frequent first-lifetime episode of depressive polarity, more frequent breakthrough episodes (p = 0.001), seasonality of episodes (p < 0.001), suicidal attempts (p = 0.003), relapses due to poor medication adherence (p = 0.003), indeterminate predominant polarity, psychotic symptoms during episodes in a lifetime, higher likelihood of receiving lithium. Conclusions: The prevalence of BD-RC course is lower compared to Western countries, but there are many similarities in the factors associated with RC in bipolar disorder between India and Western countries.