ABSTRACT
Cyclicity is the hallmark of bipolar disorder, and is especially prominent in patients with a rapid cycling course (Goodwin & Jamison, 2007). Among patients with bipolar disorder, manic, hypomanic, depressive, and mixed episodes may occur in any given sequence and frequency. As early as in 1809, an English physician John Haslam, described the frequent alternation of mania and depression as a bad prognostic sign: “When the furious state is succeeded by melancholy, and after this shall have continued a short time, the violent paroxysm returns, the chance of recovery is very slight. Indeed, whenever these states of the disease frequently change, such alterations may be considered as very unfavorable.”
