Clinical and Biological Findings in a Case With 48-Hour Bipolar Ultrarapid Cycling Before and During Valproate Treatment
J Clin Psychiatry 2000;61(8):585-593
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: The rare cases of patients with
48-hour ultrarapid cycling allow close investigation of mood
cycles in affective disorders, because rhythmic changes in
psychopathologic state and biological parameters happen very
Method: A 67-year-old white man who had
experienced bipolar 48-hour ultrarapid cycling (DSM-IV 296.80)
for several years was studied without any medication and then
again studied 4 weeks later during treatment with valproate (1800
Results: Objective and self ratings revealed
pronounced manic states 1 day and depressed states the following
day, which were found to be accompanied by rhythmic fluctuations
in behavior and electroencephalographic parameters, blood
cortisol and growth hormone levels (both elevated on depressive
days), and urinary metanephrine (dopamine metabolite) and
norepinephrine levels (both elevated on manic days). Using single
photon emission computed tomography, regional blood flow in the
left thalamus was lower than in the right thalamus on the manic
day, while symmetric perfusion of the thalamus was found on the
depressive day. Under valproate treatment, the patient remitted
completely, and significant rhythmic changes in most of the
biological parameters were no longer detectable.
Conclusion: The biological findings in this
patient with bipolar 48-hour ultrarapid cycling, which correspond
to those in other types of affective disorders, suggest that
disturbances in the diencephalon-pituitary axis may be especially
correlated to pathologic changes of mood.