A Manic Depressive Psychotic with a Persistent Forty-eight Hour Cycle

Jenner, F. A.; Gjessing, L. R.; Cox, J. R.; Davies-Jones, A.; Hullin, R. P.; Hanna, S. M.

doi:10.1192/bjp.113.501.895

Cited by 95 publications

(17 citation statements)

References 32 publications

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“…1,9,10 More recent studies have confirmed these earlier observations in small samples of well diagnosed BPD patients using systematic prospective study designs with well-validated rating instruments administered at 2-h intervals. 8,25 These studies indicate that a distinct pattern of UURC or ultradian cycling can be reliably distinguished from classical rapid-cycling affective episodes (months to weeks).…”

supporting

confidence: 65%

Ultra-ultra rapid cycling bipolar disorder is associated with the low activity catecholamine-O-methyltransferase allele

Papolos

Veit

Faedda³

et al. 1998

Mol Psychiatry

163

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Bipolar spectrum disorders are recurrent illnesses characterized by episodes of depression, hypomania, mania or the appearance of mixed states. Great variability is evident in the frequency of episode recurrence and duration. 1-3 In addition to regular circannual episodes, 4 a spectrum of cycle frequencies has been observed, from the classical rapid cycling (RC) pattern of four or more episodes per year, 5,6 to those with distinct shifts of mood and activity occurring within a 24-48 h period, described as ultra-ultra rapid cycling (UURC) or ultradian cycling. 7-10 RC has a female preponderance, and occurs with greater frequency premenstrually, at the puerperium and at menopause. 11,12 Tricyclic antidepressants and MAOIs, both of which increase functional monoamines norepinephrine, dopamine and serotonin, are known to precipitate mania or rapid-cycling in an estimated 20-30% of affectively ill patients. [13][14][15] We have recently reported a strong association between velo-cardio-facial syndrome (VCFS) patients diagnosed with rapid-cycling bipolar disorder, and an allele encoding the low enzyme activity catechol-O-methyltransferase variant (COMT L). 16,17 Between 85-90% of VCFS patients are hemizygous for COMT. 18 Homozygosity for the low activity allele (COMT LL) is associated with a 3-4 fold reduction of COMT enzyme activity compared with homozygotes for the high activity variant (COMT HH). 19,20 There is nearly an equal distribution of L and H alleles in Caucasians. 21 Individuals with COMT LL would be expected to have higher levels of transynaptic catecholamines due to a reduced COMT degradation of norepinephrine and dopamine. We therefore hypothesized that the frequency of COMT L would be greater in RC BPD ascertained from the general population. Significantly, we found that the frequency of COMT L was higher in the UURC variant of BPD than among all other groups studied (P = 0.002). These findings indicate that COMT L could represent a modifying gene that predisposes to ultra-ultra or ultradian cycling in patients with bipolar disorder.The study included eight patients diagnosed with BPD I, 17 with BPD II, and three co-morbid with obsessive-compulsive disorder (OCD). Childhood or adolescent onset of illness was reported in all 25 of the patients, 17 (83%) began before puberty. Of six UURC patients, five had childhood onsets with 'de novo' ultra-ultra rapid cycling (ie, not antidepressantinduced). This form of cycling has recently been reported to be common in childhood-onset BPD. 22 A sizable majority, 23/25 (92%) of the patients reported having had cycle acceleration when treated with antidepressants (Table 1).COMT genotype was determined in 24 women and one man diagnosed as rapid-cyclers by DSM-IV criteria. Of six patients found to have UURC, five were women. We and others have found that there is no association between COMT genotype and patients with BPD when patients are not selected for cycle frequency. 23,24 Similarly, there was no difference when the frequency of the COMT polymorphism in this group...

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supporting

confidence: 65%

Ultra-ultra rapid cycling bipolar disorder is associated with the low activity catecholamine-O-methyltransferase allele

Papolos

Veit

Faedda³

et al. 1998

Mol Psychiatry

163

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“…The mood changes, which had been experienced over several years by the patient, occurred with clockwise regularity similarly to cases described earlier Jenner et al, 1967;Doerr et al, 1979;King et al, 1979;Gann et al, 1993;Kramlinger and Post, 1996]. As in other cases with 48-hour rapid cycling, the disorder began without a preceding history of bipolar or any other affective disorder.…”

Section: Discussionsupporting

confidence: 51%

Neurobiological Findings before and during Successful Lithium Therapy of a Patient with 48-Hour Rapid-Cycling Bipolar Disorder

Voderholzer¹,

Weske²,

Ecker³

et al. 2002

Neuropsychobiology

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48-hour rapid cycling is a very rare form of bipolar disorder, characterized by regular periodic changes of mood from one day to the other. We report on a patient who suffered from a 48-hour rapid cycling without a history of bipolar disorder before the abrupt onset of his rapid mood cycles. We present polysomnographic and neuroendocrine findings and the clinical course based on daily self-ratings of mood. Treatment with lithium carbonate effectively reduced the amplitude of the mood cycles. With plasma levels between 0.8 and 1.0 mmol, almost complete remission occurred. An overview on previous reports on the therapeutic effect of mood stabilizers in this rare form of bipolar disorder is presented.

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“…Both high-and low frequency cycles have been reported in other studies for various species, including primates. Ultradian cycles have been observed in human (Schaefer et al, 1967) and in monkeys (Winget et al, 1968); and infradian cycles have been reported for humans (Halberg, 1965;Jenner et al, 1967Jenner et al, , 1968, and suggested for monkeys (Richter, 1968). More research is needed before the significance and validity of such cycles can be determined.…”

mentioning

confidence: 91%

Activity cycles of the rhesus monkey(Macaca mulatta)under several experimental conditions, both in isolation and in a group situation∗∗∗

Yellin

Hauty

1971

Journal of Interdisiplinary Cycle Research

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A Manic Depressive Psychotic with a Persistent Forty-eight Hour Cycle

Cited by 95 publications

References 32 publications

Ultra-ultra rapid cycling bipolar disorder is associated with the low activity catecholamine-O-methyltransferase allele

Ultra-ultra rapid cycling bipolar disorder is associated with the low activity catecholamine-O-methyltransferase allele

Neurobiological Findings before and during Successful Lithium Therapy of a Patient with 48-Hour Rapid-Cycling Bipolar Disorder

Activity cycles of the rhesus monkey(Macaca mulatta)under several experimental conditions, both in isolation and in a group situation∗∗∗

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