Sleep and sleep-wake cycle in an 81-year-old patient with de novo ultra-rapid cycling bipolar disorder.
This is a case report of an 81-year-old man who developed de novo bipolar disorder with ultrarapid cycling at the age of 80. Mood was self-rated daily over a period of ten weeks; in addition, polysomnographic and motor activity recordings were performed during a drug-free baseline period. Both depressive and hypomanic episodes had an average duration of about 30 hours; the affective cycle was thus independent from the sleep-wake cycle. When mood shifts occurred during nighttime, sleep was different in nights following depression than in nights following hypomania. Positron emission tomography revealed a moderate bilateral frontal hypermetabolism in the hypomanic phase and yielded normal findings for the depressive stage. In contrast to what is usually expected in ultra-rapid cycling bipolar disorder, this case demonstrates an unusual sleep-unrelated cycle duration in the oldest reported patient so far.
Schreiner
R
R
Department of Neurology and Clinical Neurophysiology, Städtisches Krankenhaus München-Bogenhausen, Englschalkinger Strasse 77, 81925 Munich, Germany. Ralph.Schreiner@lrz.tum.de
Mirisch
S
S
Vesely
Z
Z
Wiegand
M H
MH
D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology; D004734:Energy Metabolism / Q000502:physiology; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology; D017286:Polysomnography; D012894:Sleep Stages / Q000502:physiology; D014055:Tomography, Emission-Computed; D014851:Wakefulness / Q000502:physiology