title: Recovery from neuroendocrinological abnormalities and frontal hypoperfusion after remission in a case with rapid cycling bipolar disorder.
abstract: A 51-year-old Japanese woman who had been suffering from a rapid cycling affective disorder (RCAD) for 24 years responded to combined clonazepam and carbamazepine therapy. Before remission, she showed neuroendocrinological and neuroimaging abnormalities such as subclinical hypothyroidism with exaggerated response to thyrotropin releasing hormone (TRH) injection, non-suppression on the dexamethasone suppression test (DST) and hypofrontality in cerebral blood flow. Her symptoms improved remarkably soon after adjunctive clonazepam treatment. After remission, her biological markers gradually returned to normal. First, subclinical hypothyroidism improved 2 months after remission. Next, hypofrontality disappeared 18 months later. Furthermore, non-suppression on the DST normalized 24 months later. The normalization of biological markers with apparent recovery from RCAD suggests a decreased risk of relapse into mood disorder. These findings reiterate the importance of following-up on the biological markers in RCAD for years after remission.
authors.affiliation: Department of Neuro-Psychiatry, School of Medicine, Chiba University, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Shimizu
authors.forename: K
authors.initials: K
authors.lastname: Kodama
authors.forename: T
authors.initials: T
authors.lastname: Sakamoto
authors.forename: N
authors.initials: N
authors.lastname: Komatsu
authors.forename: N
authors.initials: N
authors.lastname: Yamanouchi
authors.forename: S
authors.initials: S
authors.lastname: Okada
authors.forename: T
authors.initials: T
authors.lastname: Sato
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D002220:Carbamazepine / Q000008:administration & dosage*; D002998:Clonazepam / Q000008:administration & dosage*; D003907:Dexamethasone; D004359:Drug Therapy, Combination; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007037:Hypothyroidism / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology; D013960:Thyroid Function Tests; D013963:Thyroid Hormones / Q000097:blood; D013972:Thyrotropin / Q000097:blood*; D013973:Thyrotropin-Releasing Hormone; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000927:Anticonvulsants; D013963:Thyroid Hormones; D002220:Carbamazepine; D002998:Clonazepam; D013973:Thyrotropin-Releasing Hormone; D003907:Dexamethasone; D013972:Thyrotropin; D006854:Hydrocortisone