DIAGNOSTIC AND THERAPEUTIC DIFFICULTIES ENCOUNTERED IN 2 PATIENTS WITH RAPID-CYCLING BIPOLAR DISORDERS

Rapid cycling bipolar disorders raise diagnostic and therapeutic issue s. There exist two opposing concepts. One distinguishes bipolar disord ers according to cycle frequencies. In extreme cases, daily alternate cycles are indistinguishable from the mixed states. In the other conce pt, different cyclical frequencies are only considered to be a symptom atic variation of the same disorder occurring during the course of the illness. We report the case of a patient who particularly illustrates on a diachronic level, the different forms of bipolar disorder. The d ifficulties with differential diagnosis are equally envisaged, notably in the case of paranoia. Rapid cycling disorder has been defined by r eference to resistance to lithium, the therapeutic problem are far fro m being solved. We report the case of a patient who responded favourab ly to iproniazine over a short period. A long term treatment with cloz apine resulted in a net improvement autonomy and a relative stabilisat ion of the cycle.