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June 1965, Vol 12, No. 6 >
Article | June 1965

Study of a Patient With 48-Hour Manic-Depressive Cycles: Title and subTitle BreakPart II. Strong Positive Correlation Between Endocrine Factors and Manic Defense Patterns

WILLIAM E. BUNNEY, JR., MD; ERNEST L. HARTMANN, MD; JOHN W. MASON, MD
[+] Author Affiliations

Submitted for publication Dec 18, 1964.


Arch Gen Psychiatry. 1965;12(6):619-625. doi:10.1001/archpsyc.1965.01720360091015
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Comments

PART I of this investigation reported the behavioral analysis of a patient with regular 48-hour manic-depressive cycles. These cycles persisted with clock-like regularity over a twoyear period of time. The second part of this study is concerned with biochemical and physiological variables as they relate to the periodic behavioral cycles in this unusual patient.

The patient, Mrs. J, was a 43-year-old, Caucasian, married female. On her depressed or low days she was retarded, expressed feelings of suffering and hopelessness, and had an acute awareness of the duration, severity, and the cyclic aspects of her illness. On the manic or high day she was hyperactive, angry, at times combative, and denied intensely the severity, the duration, and the periodic 24-hour changes in her behavior.

Urinary 17-hydroxycorticosteroids (17OHCS) were selected for the major focus of the endocrine aspect of this investigation.

A number of workers have reported

REFERENCES

1 +
Rizzo, N. D., et al:  Concurrent Observations of Behavior Changes and of Adrenocortical Variations in a Cyclothymic Patient During a Period of 12 Months , Ann Intern Med 41:798-815, 1954;.
2 +
Bryson, R. W., and Martin, D. F.:  17-Ketosteroid Excretion in a Case of Manic-Depressive Psychosis , Lancet 2:365-367, 1954;.
3 +
Fox, H. M., et al:  Urinary 17-Hydroxycorticoid and Uropepsin Levels With Psychological Data , Arch Intern Med 101:859-871, 1958;.
4 +
Gibbons, J. L., and McHugh, P. R.:  Plasma Cortisol in Depressive Illness , J Psychiat Res 1:162-171, 1962;.
5 +
Board, F.; Wadeson, R.; and Persky, H.:  Depressive Affect and Endocrine Functions , Arch Neurol Psychiat 78:612-620, 1957;.
6 +
Gibbons, J. L.:  Cortisol Secretion Rate in Depressive Illness , Arch Gen Psychiat 10:572-575, 1964;.
7 +
Kurland, H. D.:  Steroid Excretion in Depressive Disorders , Arch Gen Psychiat 10:554-560, 1964;.
8 +
Bunney, W. E., Jr.; Mason, J. W.; and Hamburg, D. A.:  Correlations Between Behavioral Variables and Urinary 17-Hydroxycorticosteroids in Depressed Patients , Psychosom Med , to be published.
9 +
Bunney, W. E., Jr., et al:  Psychoendocrine Study of Severe Psychotic Depressive Crises , Amer J Psychiat , to be published.
10 +
Wolff, C. T., et al:  Relationship Between Psychological Defenses and Mean Urinary 17-Hydroxycorticosteroid Excretion Rates: I. Predictive Study of Parents of Fatally Ill Children , Psychosom Med 26:576-591, 1964;.
11 +
Wolff, C. T.; Hofer, M. A.; and Mason, J. W.:  Relationship Between Psychological Defenses and Mean Urinary 17-Hydroxycorticosteroid Excretion Rates: II. Methodologic and Theoretical Considerations , Psychosom Med 26:592-609, 1964;.
12 +
Bliss, E. L., et al:  Reaction of Adrenal Cortex to Emotional Stress , Psychosom Med 18:56-76, 1956;.
13 +
Bunney, W. E., Jr., and Hamburg, D. A.:  Methods for Reliable Longitudinal Observation of Behavior , Arch Gen Psychiat 9:114-128, 1963;.
14 +
Glenn, E. M., and Nelson, D. H.:  Chemical Method for Determination of 17-Hydroxycorticosteroids and 17-Ketosteroids in Urine Following Hydrolysis With β-Glucuronidase , J Clin Endocrinol 13:911-921, 1953;.
15 +
Rosenthal, W. R., and Mason, J. W.:  Urinary 17Hydroxycorticosteroid Excretion in Normal Rhesus Monkey , J Lab Clin Med 53:720-728, 1959;.
16 +
Dooley, L.:  Relation of Humor to Masochism , Psychoanal Rev 28:37-46, 1941;.
17 +
Lewin, B.: Psychoanalysis of Elation , New York: W. W. Norton & Co., 1950;.
18 +
Cohen, M. B., et al:  Intensive Study of 12 Cases of Manic-Depressive Psychosis , Psychiatry 17:103-137, 1954;.

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1 +
Rizzo, N. D., et al:  Concurrent Observations of Behavior Changes and of Adrenocortical Variations in a Cyclothymic Patient During a Period of 12 Months , Ann Intern Med 41:798-815, 1954;.
2 +
Bryson, R. W., and Martin, D. F.:  17-Ketosteroid Excretion in a Case of Manic-Depressive Psychosis , Lancet 2:365-367, 1954;.
3 +
Fox, H. M., et al:  Urinary 17-Hydroxycorticoid and Uropepsin Levels With Psychological Data , Arch Intern Med 101:859-871, 1958;.
4 +
Gibbons, J. L., and McHugh, P. R.:  Plasma Cortisol in Depressive Illness , J Psychiat Res 1:162-171, 1962;.
5 +
Board, F.; Wadeson, R.; and Persky, H.:  Depressive Affect and Endocrine Functions , Arch Neurol Psychiat 78:612-620, 1957;.
6 +
Gibbons, J. L.:  Cortisol Secretion Rate in Depressive Illness , Arch Gen Psychiat 10:572-575, 1964;.
7 +
Kurland, H. D.:  Steroid Excretion in Depressive Disorders , Arch Gen Psychiat 10:554-560, 1964;.
8 +
Bunney, W. E., Jr.; Mason, J. W.; and Hamburg, D. A.:  Correlations Between Behavioral Variables and Urinary 17-Hydroxycorticosteroids in Depressed Patients , Psychosom Med , to be published.
9 +
Bunney, W. E., Jr., et al:  Psychoendocrine Study of Severe Psychotic Depressive Crises , Amer J Psychiat , to be published.
10 +
Wolff, C. T., et al:  Relationship Between Psychological Defenses and Mean Urinary 17-Hydroxycorticosteroid Excretion Rates: I. Predictive Study of Parents of Fatally Ill Children , Psychosom Med 26:576-591, 1964;.
11 +
Wolff, C. T.; Hofer, M. A.; and Mason, J. W.:  Relationship Between Psychological Defenses and Mean Urinary 17-Hydroxycorticosteroid Excretion Rates: II. Methodologic and Theoretical Considerations , Psychosom Med 26:592-609, 1964;.
12 +
Bliss, E. L., et al:  Reaction of Adrenal Cortex to Emotional Stress , Psychosom Med 18:56-76, 1956;.
13 +
Bunney, W. E., Jr., and Hamburg, D. A.:  Methods for Reliable Longitudinal Observation of Behavior , Arch Gen Psychiat 9:114-128, 1963;.
14 +
Glenn, E. M., and Nelson, D. H.:  Chemical Method for Determination of 17-Hydroxycorticosteroids and 17-Ketosteroids in Urine Following Hydrolysis With β-Glucuronidase , J Clin Endocrinol 13:911-921, 1953;.
15 +
Rosenthal, W. R., and Mason, J. W.:  Urinary 17Hydroxycorticosteroid Excretion in Normal Rhesus Monkey , J Lab Clin Med 53:720-728, 1959;.
16 +
Dooley, L.:  Relation of Humor to Masochism , Psychoanal Rev 28:37-46, 1941;.
17 +
Lewin, B.: Psychoanalysis of Elation , New York: W. W. Norton & Co., 1950;.
18 +
Cohen, M. B., et al:  Intensive Study of 12 Cases of Manic-Depressive Psychosis , Psychiatry 17:103-137, 1954;.

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