Introduction: Bipolar Disorder (BD) presents with heterogeneous longitudinal cycling patterns, including Manic-Depressive-free Interval (MDI), Depressive-Manic-free Interval (DMI), and Irregular (IRR) cycles. Studies investigating how these cycle types affect clinical course remain limited. This study aimed to examine a large, well-characterised sample of patients with BD types I (BD-I) and II (BD-II). Methods: Life charts were used to determine the type of cycle, collecting information on first affective episode type, hospitalisations (presence or absence), suicidal ideation/attempts, psychiatric family history, seasonality, agitated depression, predominant polarity, and diagnostic subtype (BD-I vs. BD-II). The impact of cycle type on clinical course was analysed through univariate and multivariate models. Results: Of 378 BD patients, 140 (37.0%) had MDI cycles, 92 (24.3%) had DMI cycles, and 146 (38.6%) had IRR cycles. Multivariate analyses showed MDI patients were more likely to have a manic onset compared to DMI and IRR (p < 0.001). They also showed a higher likelihood of hypomanic onset compared to DMI (p < 0.001). Conversely, DMI was associated with a depressive onset relative to MDI and IRR (p < 0.001). Seasonality was more frequent in patients with regular cycles (MDI and DMI) compared to IRR (p < 0.001). Hospitalisations were more frequent in MDI and DMI cycles compared to IRR, but the association survived only for MDI in multivariate analysis. MDI patients had a higher prevalence of manic predominant polarity and lower rates of depressive predominant polarity compared to both DMI and IRR (p < 0.001). A BD-II diagnosis was significantly more frequent in DMI and IRR (p < 0.001), and a BD-I diagnosis was more prevalent in MDI (p < 0.001). Discussion: Cycle type affected the BD clinical course, with MDI tending to show more frequent hospitalisations, BD-I diagnosis, and manic predominant polarity, while DMI and IRR patients had more BD-II diagnoses. Conclusion: Findings underscore the importance of classifying BD based on cycle patterns and suggest that taking into account these patterns may support more personalised treatment planning and improve clinical outcomes.
Clinical and Prognostic Relevance of Cycle Pattern Recognition in Bipolar Disorder: A Further Step Toward Personalised Treatment Pathways?
Alexia Koukopoulos;Giovanni Camardese;
2026-01-01
Abstract
Introduction: Bipolar Disorder (BD) presents with heterogeneous longitudinal cycling patterns, including Manic-Depressive-free Interval (MDI), Depressive-Manic-free Interval (DMI), and Irregular (IRR) cycles. Studies investigating how these cycle types affect clinical course remain limited. This study aimed to examine a large, well-characterised sample of patients with BD types I (BD-I) and II (BD-II). Methods: Life charts were used to determine the type of cycle, collecting information on first affective episode type, hospitalisations (presence or absence), suicidal ideation/attempts, psychiatric family history, seasonality, agitated depression, predominant polarity, and diagnostic subtype (BD-I vs. BD-II). The impact of cycle type on clinical course was analysed through univariate and multivariate models. Results: Of 378 BD patients, 140 (37.0%) had MDI cycles, 92 (24.3%) had DMI cycles, and 146 (38.6%) had IRR cycles. Multivariate analyses showed MDI patients were more likely to have a manic onset compared to DMI and IRR (p < 0.001). They also showed a higher likelihood of hypomanic onset compared to DMI (p < 0.001). Conversely, DMI was associated with a depressive onset relative to MDI and IRR (p < 0.001). Seasonality was more frequent in patients with regular cycles (MDI and DMI) compared to IRR (p < 0.001). Hospitalisations were more frequent in MDI and DMI cycles compared to IRR, but the association survived only for MDI in multivariate analysis. MDI patients had a higher prevalence of manic predominant polarity and lower rates of depressive predominant polarity compared to both DMI and IRR (p < 0.001). A BD-II diagnosis was significantly more frequent in DMI and IRR (p < 0.001), and a BD-I diagnosis was more prevalent in MDI (p < 0.001). Discussion: Cycle type affected the BD clinical course, with MDI tending to show more frequent hospitalisations, BD-I diagnosis, and manic predominant polarity, while DMI and IRR patients had more BD-II diagnoses. Conclusion: Findings underscore the importance of classifying BD based on cycle patterns and suggest that taking into account these patterns may support more personalised treatment planning and improve clinical outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
