Rapid cycling in unipolar and bipolar affective disorders.

To characterize the nature of rapid cycling affective disorders, the authors analyzed mood fluctuation patterns in 570 patients with affective disorders hospitalized in 1960, 1975, or 1985. Patients' records were rated for the frequency, duration, and complexity of distinct affective states. Very rapid mood fluctuations were absent among bipolar patients in 1960 but were evident in 1975 and 1985. In each year, bipolar patients displayed more frequent, complex, and mixed episodes than did unipolar patients. The results suggest that more frequent episodes occur among bipolar than unipolar patients and that very rapid switch processes have become more widespread for some bipolar patients.

Intractable manic-depressive psychosis with rapid cycling in an 18-year-old woman successfully treated with electroconvulsive therapy.

An adolescent patient with a history of progressively more severe seasonal depression subsequently developed a refractory manic-depressive psychosis with rapid cycling after the initiation of treatment with trimipramine. A complete remission was obtained after a course of six electroconvulsive therapy (ECT) treatments. This unusual case and its outcome are discussed in terms of apparent drug-induced rapid cycling and the treatment of this condition. It is suggested that ECT can be successfully used as an alternative therapeutic option for patients with intractable rapid-cycling manic-depressive disorder.

Memory scanning and retrieval in affective disorders.

Previous studies have consistently demonstrated unimpaired memory scanning and retrieval in schizophrenic patients. Using the choice-reaction time paradigm, this study assessed the speed of short-term memory processing for pictorial information in both unipolar and bipolar depressives by comparing it with that of schizophrenics. It was found that the processing rate is comparable between depressives and schizophrenics, between unipolar and bipolar depressives, and between depressives on medication and those not on medication. It was concluded, therefore, that the short-term memory scanning and retrieval processes are not impaired in depressive patients. The results further suggested that the depressives' slowness often found in simple reaction time tasks may result from a dysfunction in their stimulus encoding and/or response execution rather than in the central information-identification process.

Coronary artery bypass in a patient on lithium carbonate prophylaxis.

What is thought to be the first case of coronary artery bypass in a patient on lithium carbonate prophylaxis is presented. A postcardiotomy delirium developed on day 2 and appeared unrelated to the underlying manic-depressive illness. A 2-year follow-up indicated apparent resolution of pre-existing psychological difficulties and no recurrence of somatic symptoms. It is suggested that lithium carbonate prophylaxis be continued with appropriate monitoring during coronary artery bypass procedures.

Memory processing with lithium carbonate.

The effect of lithium carbonate treatment on the memory processing of manic-depressive patients was assessed in three memory tasks. The results suggested that memory performance and the underlying organizational processes are not adversely affected by lithium treatment.

Lithium toxicity with hypothyroidism as a possible determinant.

A case of a woman with severe lithium toxicity and hypothyroidism with persistent hyponatremia and hypokalemia is presented. The mechanisms of the development of lithium toxicity by alterations in fluid and sodium metabolism, including those induced by lithium itself, are reviewed. The possibility that hypothyroidism may have been a significant determinant in the development of this case of lithium toxicity is considered and discussed. This is of special interest given that lithium can induce hypothyroidism. In addition, the safe reinstitution of lithium prophylaxis in this woman can be reported.

Manic-depressive illness in adolescence.

The efficacy of lithium carbonate as a treatment for manic-depressive illness has stimulated a reevaluation of the syndrome. In this paper, the authors review the obstacles to timely diagnosis of manic-depressive illness in the adolescent. Three cases are presented demonstrating the usefulness of a unitary concept in which manic-depressive illness is understood and appreciated as having a physiologic basis, manifesting its effects in the total body system. The heterofore diverse and confusing psychological and behavioral symptoms of manic depressive illness in adolescents become intelligible when regarded as secondary phenomena: the psychic experience of the process as filtered through the psychological constitution of the individual adolescent.

Death from fright: report of a case and literature review.

A case report is presented illustrating the thesis that fear of fantasy material may trigger off a physiological process leading to death.