Fj. Bayle et al., DIAGNOSTIC AND THERAPEUTIC DIFFICULTIES ENCOUNTERED IN 2 PATIENTS WITH RAPID-CYCLING BIPOLAR DISORDERS, Annales medico-psychologiques, 156(8), 1998, pp. 552-556
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.