Clinical and Biological Findings in a Case With 48-Hour Bipolar Ultrarapid Cycling Before and During Valproate Treatment

Background: The rare cases of patients with48-hour ultrarapid cycling allow close investigation of moodcycles in affective disorders, because rhythmic changes inpsychopathologic state and biological parameters happen veryprecisely.

Method: A 67-year-old white man who hadexperienced bipolar 48-hour ultrarapid cycling (DSM-IV 296.80)for several years was studied without any medication and thenagain studied 4 weeks later during treatment with valproate (1800mg/day).

Results: Objective and self ratings revealedpronounced manic states 1 day and depressed states the followingday, which were found to be accompanied by rhythmic fluctuationsin behavior and electroencephalographic parameters, bloodcortisol and growth hormone levels (both elevated on depressivedays), and urinary metanephrine (dopamine metabolite) andnorepinephrine levels (both elevated on manic days). Using singlephoton emission computed tomography, regional blood flow in theleft thalamus was lower than in the right thalamus on the manicday, while symmetric perfusion of the thalamus was found on thedepressive day. Under valproate treatment, the patient remittedcompletely, and significant rhythmic changes in most of thebiological parameters were no longer detectable.

Conclusion: The biological findings in thispatient with bipolar 48-hour ultrarapid cycling, which correspondto those in other types of affective disorders, suggest thatdisturbances in the diencephalon-pituitary axis may be especiallycorrelated to pathologic changes of mood.