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The author reports on 7 patients with a primary diagnosis of manic-depressive psychosis who had brief but well-defined episodes of paranoid symptomatology. These episodes apparently represent alterations of psychic defense structure during the dynamic flow of the psychosis toward recovery. In manic-depressive psychosis, with its genetic and physiologic components, the paranoid episodes reaffirm the unitary nature of humans, in whom heredity and physical and psychological factors inextricably interact.
The mechanism of action lithium in the treatment of manic-depressive illness is far from being known. A great progress will be achieved when it is known wherther lithium has an actual anti-depressive action, which implies to determine whether all the "endogenous" depressive states belong to the same pathogenic group. Lithium salts have a real therapeutic action on manic states which may be put together with the decrease of available Norepinephrine that lithium salts bring about on cerebral receptors. This decrease concords with the aminergic theory of affective disorders. Many actions of lithium salts on the physiologic systems have been brought to evidence but the uncertainties that remain concerning their interactions prevent us to formulate any coherent assumption.
A free word association quantitative test gave significantly different results in two groups of manic depressive patients (n = 18, n = 33) compared to two groups of neurotics (n = 25, n = 30) and two groups of controls (n = 29, n = 57). The biggest difference was between manic depressed and neurotics. Such measurements are considered to provide an approach to the reality system that differs in manic depressed and neurotics or controls.
The aim of the present study was to investigate geographical variations in first ever admission rates for manic-depressive psychosis during the period 1977 to 1993 at a county level. The analyses were based on data obtained from the national Danish Psychiatric Case Register comprising inpatient contacts to Danish psychiatric hospitals and psychiatric units in general hospitals. The results showed that the national first ever admission rates for manic-depressive psychosis in the age-group 15-74 years declined by 44% from 25.3 per 100,000 in 1977-1979 to 14.2 per 100,000 in 1991-1993. For the older age-group the rates were slightly increasing. Comparison of the individual counties revealed significantly geographical variations with respect to incidence level and temporal trends over the years 1977-1993. The results may reflect local differences in the provision of outpatient services and primary care facilities. However, there is also the possibility that some patients might never be treated.
In psychiatry, lithium salts are used alone, or in combination with neuroleptics, in the treatment of manic states and in the prophylaxis of manic or melancholic relapses in cyclophrenia. They are also used by some clinicians to prevent relapses of melancholia. To be efficient, the blood level of lithium must be between 0,8 and 1,2 mEq/liter in chronic treatment, and much higher in acute treatment. Side effects can be present, but do not warrant to stop the treatment; meanwhile there are signs of intoxication which necessitate immediate treatment interruption. This medication should be given to motivated patients, of normal intelligence, suffering from repeated states of mania or melancholia, because it is a long term treatment requiring constant supervision.
According to the "Chronopathological theory of manicdepressive disorder" (Supprian: "Ordnung und Psychose" pubd. by R. Krämer Hamburg 1988, ISBN: 3 926952 07 5), the syndromatic day-to-day shifting of the psychopathological features with manic, depressive and several mixed states has a well-defined time structure, as in 25 patients studied and reported on in this paper. This time structure is given with a chronobiological cycle of an (individual) length and an inherent sequence of psychopathological phenomena (the theory stipulates a series of several cycles--from rapid to long-term-periodicity--and related sequences). Within this order the psychopathological surface of each day is strictly determined by its numeric position in the cycle. The several states and the individual comments on suicide (from announcement to dissimulation or distancing and to trying out and execution, etc.) can be described by means of affective disorders, a special casted typology of 12 types. The material for this study consisted of 25 cases with a well-known time-structure (obtained via previous analyses by computer-aided sequence spectra) and 178 text extracts from patients histories, compiled in a booklet, one for each expert. 10 independent experts (psychiatrists and psychologists) rated the typology of each text. Statistical studies of frequency tables (Chi2-technique) show a close matching between psychopathologic and suicidological states. Final action, for example, is correlated with an overall dysregulation of the mood system (with no dependence on the drive system--contrary to a widespread doctrine). Any lack of drive can be instrumentally compensated. Timing of suicide (and all other types of translation into reality) during the course of an affective disorder could be shown as being strictly determined by the endogenous process and its time structure. The results confirm the chronopathological theory.
The author performed a clinical study of 492 depressive, 127 manic and 46 double phases in 150 patients with manic-depressive psychosis where the disorder manifested itself after the age of 40 with an average duration of the disease of about 10 years. Some general regularities in the syndrome formation and syndrome modifications of the depressive (from subdepressive to endogenous, anxious and delusional depressions) and manic (from hypo and endogenous mania to angry, aproductive mania with pseudoparalytical and senile like traits) syndromes were displayed. It was demonstrated that supplementary factors facilitated such changes as well. The acheived data permitted to qualify longitudinaly more precisely the manic-depressive psychosis during involution as well as to determine the frequency of separate symptoms in each depressive or manic phase.
Clonazepam, which is a benzodiazepine structurally related to chlordiazepoxide hydrochloride, diazepam and nitrazepam, has been available for the treatment of seizure disorders in the USA since 1976 and in Japan since 1981. Recently, clonazepam has attracted interest as drug for the treatment of manic-depressive psychosis. Chouinard et al (1983), Victor et al (1984), Freinhar and Alvarez (1985) and Santos and Morton (1987) have reported on the antimanic properties of clonazepam, and Jones and Chouinard (1985), Zetine and Freedman (1986), Mas et al (1993) and Kishimoto et al(1987) have reported on the antidepressive properties of clonazepam. We have observed the antimanic and antidepressive properties of clonazepam as well. Clonazepam is a useful therapeutic adjunct and the onset of its effect is rapid. We cannot, however, advocate the use of only the therapeutic agent for amelioration of manic-depressive psychosis. Clonazepam is a useful supplement and has a diverse optimum daily dose for acute manic and depressive states. Clonazepam should, at the time, be considered only as an alternative treatment for patients nonresponsive to conventional therapy, and should be used at a dosage of 3-6 mg/day for depressive state and 10 mg/day for acute manic state in combination with other psychotropic drugs.
A sample of 38 adolescents hospitalized for a major depressive episode melancholic type or a manic episode during the course of a bipolar disorder (according to the DSM III-R Criteria) was examined with particular emphasis on precipating life events and family relationships. Psychosocial stressors in the year preceding onset of the affective disorder were found in a very high proportion of cases (about 80%). Stressors are most often severe. All of these stressors have to do with loss or threat of loss, particularly the most frequent one: the sentimental failure. Analyzing results of a familial dynamic questionnaire, we showed in the MDD sample the prevalence of two psychopathological index: maternal rejection, parental dysharmony.
Fifty consecutive patients with bipolar affective psychosis are reviewed, and the genetic and electroencephalographic findings set against extant hypotheses about inheritance of the disorder and the etiological homogeneity of the syndrome. Inheritance in this sample appears usually not to be X-linked. The syndrome seems etiologically heterogeneous in that some patients have an early onset and prominent genetic determinants, while in others without apparent hereditary predisposition, the illness start later and show electroencephalographic evidence of cerebral dysfunction.
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