Cyclic 48-hour unipolar depression

This single case study reports on a 74-year-old woman with 48-hour cycles of mood disturbance for 2 years. Every other day she awakened feeling sad with low energy, decreased appetite, fatigue, diminished enjoyment of normal activities, increased irritability, occasional self-deprecatory thoughts, and difficulty concentrating. On alternative days she was active, outgoing, energetic, and cheerful. Her past history was marked by mild postpartum depressions, not requiring treatment, with each of her six pregnancies, and a more severe depression at age 57, which seemed to respond to Premarin. During the recent 2-year period of mood swings, the patient was given trials of several heterocyclic antidepressant medications, but side effects precluded the use of therapeutic doses or durations of treatment. Reluctantly, the patient agreed to a trial of lithium carbonate. After the second week of lithium treatment, at a level of 0.4 mEq/ml, she reported marked improvement, feeling fine every day without mood fluctuations. After almost 1 year at this blood level, she remains asymptomatic. Thus, the patient's cyclic 48-hour unipolar depression responded dramatically and completely to low doses of lithium carbonate.     

Mood states and 24-hour cardiac monitoring

The heart rate was measured continuously over a 24-hr period of ordinary daily activities outside the laboratory in 33 subjects by means of a portable electrocardiographic tape recorder. Self-report measures yielded psychological variables that correlated with heart rate at certain times of day and night. These correlations differed between men and women. The authors conclude that technological advances in recording under naturalistic conditions will be useful in psychosomatic research although a number of factors that influence physiological systems cannot be completely controlled.     

Free-running circadian rhythm of melatonin in a sighted man despite a 24-hour sleep pattern: A non-24-hour circadian syndrome

Abstract Sleep and plasma melatonin rhythms were measured longitudinally in a sighted young man (21 years old) under a day-night environment. At each measurement, the responsiveness of the melatonin rhythm to a single light pulse was examined in addition to the 24-hour profile. In experiment 1, the timing of sleep was decided by the subject himself. Although most sleep episodes were observed between 21:02 h and 10:55 h, the plasma melatonin rhythm free-ran for a period of 24.18 h. In experiment 2, the sleep-wake schedule of the subject was strictly fixed. The subject was instructed to go to bed at 24:00 h and wake up, at the latest, before 8:00 h for 40 days. The melatonin rhythm, however, continued to free-run for a period of 24.12 h. Nocturnal melatonin level could not be suppressed by a 3-hour light pulse of 500 lx, but was suppressed by a pulse of 1000 lx. It is concluded that internal desynchronization occurred in this particular sighted subject where the sleep-wake rhythm was entrained by the 24-hour day-night environment, whereas the plasma melatonin rhythm free ran, and that a forced sleep schedule did not act as a strong zeitgeber.     

24-hour rhythmicity of seizures in refractory focal epilepsy

The occurrence of seizures in specific types of epilepsies can follow a 24-hour nonuniform or nonrandom pattern. We described the 24-hour pattern of clinical seizures in patients with focal refractory epilepsy who underwent video-electroencephalography monitoring. Only patients who were candidates for epilepsy surgery with an unequivocal seizure focus were included in the study. A total of 544 seizures from 123 consecutive patients were analyzed. Specific time of seizures were distributed along 3- or 4-hour time blocks or bins throughout the 24-hour period. The mean age of the subjects was 37.7 years, with standard deviation of 11.5 years, median of 37. The majority were females (70/56%). The majority of patients had a seizure focus located in the mesial temporal lobe (102/83%) and in the neocortical temporal lobe (13/11%). The remaining patients had a seizure focus located in the extratemporal lobe (8/6%). The most common etiology was mesial temporal sclerosis (86/69.9%). Nonuniform seizure distribution was observed in seizures arising from the temporal lobe (mesial temporal lobe and neocortical temporal lobe), with two peaks found in both 3- and 4-hour bins: 10:00–13:00/16:00–19:00 and 08:00–12:00/16:00–20:00 respectively (p = 0.004). No specific 24-hour pattern was identified in seizures from extratemporal location. The 24-hour rhythmicity of seizure distribution is recognized in certain types of epilepsy, but studies on the topic are scarce. Their replication and validation is therefore needed. Our study confirms the bimodal pattern of temporal lobe epilepsy independently of the nature of the lesion. However, peak times differ between different studies, suggesting that the ambient, rhythmic exogenous factors or environmental/social zeitgebers, may modulate the 24-hour rhythmicity of seizures. Characterization of these 24-hour patterns of seizure occurrence can influence diagnosis and treatment in selected types of epilepsy, such as the case of temporal lobe epilepsy, the most common drug-resistant epilepsy.     

Decreased 24-hour urinary MHPG in childhood autism.

The authors compared a group of boys with childhood autism and a group of normal boys of similar age and found a decrease in urinary 3-methoxy-4-hydroxyphenethylene glycol (MHPG) in the autistic group. They hypothesize that autistic children might have an alteration in central and peripheral noradrenergic function, which might be related to impaired regulation of attention, arousal, and anxiety.     

Panic attacks and 24-hour ambulatory EEG monitoring]

A 24 hour ambulatory EEG study performed in a population of 300 non epileptic outpatients with an anxious and depressive pathology revealed a high prevalence of abnormalities in subjects referred with panic disorder. Two groups of 150 medication-free patients each have been selected on the base of DSM-III-R = one with panic attacks (PA), the other with depressive patients without paroxystic anxiety (DS). The results showed respectively = in the PA group 63.2% abnormal, 19.7% normal and 17.1% dubious records. In the DS group = 74.5% normal, 18.3% abnormal and 7.2% dubious records. Epileptiform abnormalities were 4 times more frequent in the PA group (80%) than in the DS group (20%). Two nycthemeral peaks were found (5-8 pm and 3 hours after awakening). MRI has permitted the discovery of abnormal cerebral images in 3 patients of the PA group (cyst of the insula, temporal and parietal cryptic angiomas, sequelae of a parietal vasculo-cerebral stroke) frequency appearing to be clearly superior to the one resulting from recent epidemiologic data. The subclinical character of 2/3 of these abnormalities refers beyond epilepsy to their signification in the field of emotive and intellectual disturbances. The paradoxal efficiency of tricyclic drugs in panic disorder, sets the problem of their eventual antiepileptic action at low doses. If recent data on standard EEG in panic disorder is available, we did not find any similar study to ours in order to confront our results.     

Partial sleep deprivation to prevent 48-hour mood cycles

The course of a patient with the phenomenon of 48-h mood cycles, including her response to medication and to systematic partial sleep deprivation, is described. She had only a partial response to tranylcypromine alone. Partial sleep deprivation during the second half of alternate nights successfully prevented depressive mood cycles. Three to four weeks after discontinuing tranylcypromine she lost her ability to sustain this regimen. This case demonstrates an interaction between antidepressant medication and partial sleep deprivation in the prevention of depressive mood cycles.     

Patients with palpitations referred for 24-hour ecg recording

Palpitations are one of the most common reasons for referral to cardiologists; most are assessed as being medically benign. Eighty consecutive subjects referred for 24-hour ECG recording completed a questionnaire at the time of assessment and a follow-up self-report questionnaire at 18 months. Many of those with and without abnormal hearts reported distress, concern about their symptoms, and limitation of everyday activities. There were few differences between these groups at assessment or at follow-up. There was little change in mental state or in disability in either group over 18 months. Present symptomatic treatment is largely ineffective and there is a need to evaluate psychological and behavioral interventions.     

Non-24-hour sleep-wake syndrome following a car accident

The authors report the case of a 39-year-old sighted woman who displayed non-24-hour sleep-wake cycles following a car accident. The phase relationship between endogenous circadian markers such as plasma melatonin and 6-sulfatoxymelatonin rhythms and self-selected sleep times was abnormal. A laboratory investigation indicated that she was sensitive to bright light as a circadian synchronizer. MRI and brain CT scans were normal, but microscopic brain damage in the vicinity of the suprachiasmatic nucleus or its output pathways is plausible.     

24-hour profile of plasma norepinephrine in affective disorders

The circadian rhythm of plasma norepinephrine (NE) was investigated in the depressed (major affective disorder, DSM III; n = 12), recovered (after 3 weeks of treatment using usual antidepressant drugs; n = 12) and normal (volunteers, age and sex matched; n = 10) states. Data analysis (based on the evaluation of circadian parameters, on the chronogram method and on the chronobiological analysis) revealed a clear NE circadian rhythm in normal subjects, a rhythm which was disturbed in depression, with amplitude reduction and abnormal phase position. These abnormalities tended to disappear during recovery since circadian parameters were similar to those of controls. These circadian abnormalities could be linked to the impairment of the peripheral and central catecholaminergic systems. They may also support the chronobiological hypothesis of affective disorders.     

Ambulatory 24-hour EEG recording in epileptic infantile spasms

Twenty-four h cassette recording (MEDILOG 9000) where obtained in 22 untreated infants (23 records) with a West syndrome (idiopathic: n = 12, symptomatic: n = 10). All these infants had had a 3 h polygraphic recording. Tracings were visually analyzed for sleep stages. Electro-clinical seizures and infraclinical discharges were listed according to their type and the stage of vigilance. Two hundred twenty-eight critical events were recorded in 22 cassette recordings: isolated spasms, clusters of spasms, partial or generalized discharges followed or not by clusters of spasms. Sixty per cent of these fits occurred during wakefulness, 27% during non REM sleep, 13% during awakening and none during REM sleep. Partial discharges, followed or not by clusters of spasms, were only present in cases with unfavourable outcome. In benign spasms the hypsarrhythmic pattern was present between spasms in each cluster, but not in cases with unfavourable outcome. Compared with 3 h polygraphic recordings, 24 h cassette recordings gave supplementary data on the presence, type and timing of seizures in 16 of out 22 cases.     

Bromocriptine and Parkinson's disease: A 16-hour clinical evaluation

The disability score (Webster rating scale) in 12 parkinsonian patients on bromocriptine treatment was evaluated hourly from 06–22 h. Bromocriptine was taken at fixed hours (06, 14, and 22 h) in equal doses. No systematic changes during the day related to bromocriptine ingestion were observed. Only one patient experienced pronounced hyperkinesia. "On-off" phenomenas were not observed during the treatment with bromocriptine.