Review article
Rapid, ultra-rapid and ultradian cycling bipolar disorder

The aim of this paper is to review recent literature on rapid, ultra-rapid cycling and ultradian bipolar disorder (BD). The fourth edition of the American diagnostic system (DSM-IV, the Diagnostic and Statistical Manual) defines rapid cycling bipolar disorder (RC) as a specific course, including at least four episodes of major depression, hypomania, mania, or mixed state within one year, occurring in any configuration. Rapid cycling bipolar disorder incidence among patients with bipolar disorder is 13-20%. Ultra-rapid cycling bipolar disorder (uRC) is defined as alternating phases of illness lasting from several days to several weeks. Ultradian cycling bipolar disorder (udRC) is defined as phase changes during the same day, every few hours. The last two subtypes of bipolar disorder (uRC and udRC) are not included in the DSM-IV, and none of these forms of BD is included in the International Statistical Classification of Diseases and Related Health Problems (ICD-10).

The paper presents a summary of above-mentioned subtypes of rapid cycling bipolar disorder, including uRC and udRC, with particular focus on clinical picture, pathogenic and triggering factors, differential diagnosis and treatment possibilities. Rapid cycling BD can be considered as one of the most extreme forms of the illness and therefore requires a specific therapeutic approach.