48-hour rapid cycling: results of psychopathometric, polysomnographic, PET imaging and neuro-endocrine longitudinal investigations in a single case.
We report a 64-year-old patient suffering from rapid cycling bipolar disorder who was studied by means of polysomnography, neuroendocrine tests and PET (positron emission tomography) imaging. In a manner only partly compatible with the cholinergic-aminergic imbalance model of mania and depression, a linkage of REM sleep disinhibition and depressive mood was observed, but no decisive REM sleep delay was seen on manic days. Growth hormone secretion after clonidine stimulation was blunted on depressive and hypomanic days. A series of total sleep deprivations led to a positive effect on psychopathology for about two weeks. Carbamazepine treatment normalized REM sleep variables, damped the amplitude of mood cycling of the patient, increased TSH and decreased FT4.
Gann
H
H
Central Institute of Mental Health, Mannheim, Germany.
Riemann
D
D
Hohagen
F
F
Strauss
L G
LG
Dressing
H
H
Müller
W E
WE
Berger
M
M
D001714:Bipolar Disorder / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D002220:Carbamazepine / Q000627:therapeutic use; D002540:Cerebral Cortex / Q000187:drug effects / Q000503:physiopathology; D002940:Circadian Rhythm / Q000187:drug effects / Q000502:physiology*; D003000:Clonidine; D004305:Dose-Response Relationship, Drug; D013006:Growth Hormone / Q000097:blood; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011569:Psychiatric Status Rating Scales; D012892:Sleep Deprivation / Q000502:physiology; D012895:Sleep, REM / Q000187:drug effects / Q000502:physiology; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014055:Tomography, Emission-Computed
D006728:Hormones; D002220:Carbamazepine; D013972:Thyrotropin; D013006:Growth Hormone; D003000:Clonidine; D013974:Thyroxine; D006854:Hydrocortisone