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Slow and Rapid Psychobiological Alterations in a Manic-depressive Patient: Clinical Phenomenology

Published online by Cambridge University Press:  29 January 2018

Frederick J. Stoddard
Affiliation:
Adult Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20014, USA
Robert M. Post
Affiliation:
Adult Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20014, USA
William E. Bunney Jr
Affiliation:
Adult Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20014, USA

Summary

A distinctive pattern of clinical change during eight affective episodes is reported in a rapidly cycling manic-depressive patient. After a rapid switch to near maximal intensity of affective symptoms, slow changes in symptomatology were documented by significant slopes and correlation coefficients over the course of each episode. Decreases in depression, anxiety, drowsiness, helplessness/hopelessness, anger, and sadness preceded the switches into mania; decreases in mania, euphoria, seeking others, and talking preceded the switches into depression. Psychologically important events appeared to regularly precede rapid mood switches. It is suggested that the consistent, slow clinical changes which occur during affective episodes may reflect part of an underlying rhythmic biological process and that environmental events may be capable of triggering a final common pathway for the mood switch during a vulnerable period.

Type
Research Article
Copyright
Copyright © Royal College of Psychiatrists 1977 

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References

Akiskal, H. S. & McKinney, W. T. (1975) Overview of recent research in depression. Integration of ten conceptual models into a comprehensive clinical frame. Archives of General Psychiatry, 32, 285305.CrossRefGoogle ScholarPubMed
Beigel, A. & Murphy, D. L. (1971) Unipolar and bipolar affective illness: differences in clinical characteristics accompanying depression. Archives of General Psychiatry, 24, 215–20.CrossRefGoogle ScholarPubMed
Brown, G. W., Bhrolchain, M. N. & Harris, T. (1975) Social class and psychiatric disturbance among women in an urban population. Sociology, 9, 225–54.CrossRefGoogle Scholar
Buchsbaum, M. S., Post, R. M. & Bunney, W. E. Jr Average evoked responses in a rapidly cycling manic-depressive patient. Biological Psychiatry, In press.Google Scholar
Bunney, W. E. Jr, Goodwin, F. K. & Murphy, D. L. (1972a) The ‘switch process’ in manic-depressive illness. III. Theoretical implications. Archives of General Psychiatry, 27, 312–17.CrossRefGoogle Scholar
Bunney, W. E. Jr, Goodwin, F. K., Murphy, D. L., House, K. M. & Gordon, E. K. (1972b) The ‘switch process’ in manic-depressive illness. II. Relationship to catecholamines, REM sleep and drugs. Archives of General Psychiatry, 27, 304–9.CrossRefGoogle ScholarPubMed
Bunney, W. E. Jr & Hamburg, D. A. (1962) Method for reliable longitudinal observation of behavior. Archives of General Psychiatry, 9, 153–60.Google Scholar
Bunney, W. E. Jr, Hamburg, D. A. & Hartman, E. L. (1965) Study of a patient with 48-hour manic-depressive cycles. I. An analysis of behavioral factors. Archives of General Psychiatry, 12, 611–18.Google Scholar
Bunney, W. E. Jr, Hamburg, D. A. & Mason, J. W. (1965) Study of a patient with 48-hour manic-depressive cycles. II. Strong positive correlation between endocrine, factors and manic defense patterns. Archives of General Psychiatry, 12, 619–25.Google ScholarPubMed
Bunney, W. E. Jr, Murphy, D. L. & Goodwin, F. K. (1972) The ‘switch process’ in manic-depressive illness. I. A systematic study of sequential behavioral changes. Archives of General Psychiatry, 27, 295302.CrossRefGoogle Scholar
Carlson, G. A. & Goodwin, F. K. (1973) The stages of mania: a longitudinal analysis of the manic episode. Archives of General Psychiatry, 28, 221–8.CrossRefGoogle Scholar
Court, J. H. (1968) Manic-depressive psychosis: an alternative conceptual model. British Journal of Psychiatry, 114, 1523–30.CrossRefGoogle ScholarPubMed
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. W., Winokur, G. & Muñoz, R. (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 5763.CrossRefGoogle ScholarPubMed
Freud, S. (1917) Mourning and melancholia. In The Complete Psychological Works (ed. Strachey, J.), 1957, Vol 14, pp 251. London: Hogarth Press.Google Scholar
Gjessing, L. P. (1974) A review of periodic catatonia. Biological Psychiatry, 8, 2432.Google ScholarPubMed
Kotin, J., Post, R. M. & Goodwin, F. K. (1973) Δ9-Tetrahydrocannabinol in depressed patients. Archives of General Psychiatry, 28, 345–8.CrossRefGoogle ScholarPubMed
Leff, M., Roatch, J. & Bunney, W. E. Jr (1970) Environmental factors preceding the onset of severe depressions. Psychiatry, 33, 293311.CrossRefGoogle ScholarPubMed
Paykel, E., Myers, J., Dienelt, M. N., Klerman, G. L., Lindenthal, J. J. & Pepper, M. P. (1969) Life events and depression. Archives of General Psychiatry, 21, 753–60.CrossRefGoogle ScholarPubMed
Post, R. M., Stoddard, F. J., Gillin, J. C., Buchsbaum, M., Runkle, D. C., Black, K. E. & Bunney, W. E. Jr (1976) Slow and rapid alterations in motor activity, sleep, and biochemistry in a cycling manic-depressive patient. Submitted to Archives of General Psychiatry. CrossRefGoogle Scholar
Richter, C. P. (1965) Biological Clocks in Medicine and Psychiatry. Springfield, Illinois: C. C. Thomas.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1975) Clinical criteria for psychiatric diagnosis and DSM III. American Journal of Psychiatry, 32, 1186–92.Google Scholar
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