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The Switch Process in Manic-Depressive Psychosis
- WILLIAM E. BUNNEY, Jr., M.D.;
- THOMAS R. WEHR, M.D.;
- J. CHRISTIAN GILLIN, M.D.;
- ROBERT M. POST, M.D.;
- FREDERICK K. GOODWIN, M.D.; and
- DANIEL P. van KAMMEN, M.D.
Abstract
Bipolar manic-depressive illness is a chronic disease in which patients experience recurrent episodes of mania and depression. Patients often change from a nonverbal, retarded depression of many months' duration to a hyperactive, psychotic, manic condition during the switch. The time required for the switch from depression into mania varies from 5 minutes to a couple of days. Just before it happens, patients experience marked insomnia and decreased rapid eye movement sleep. It is hypothesized that specific changes in brain monoamine metabolism precede the switch. Alterations in neurotransmitter metabolites, as measured in urine and cerebrospinal fluid, may precede and accompany it. The switch into mania can be precipitated by environmental stresses or by drugs that act by increasing functional brain monoamines. Drugs that reverse the manic state all share the common property of affecting biogenic amines. The switch into mania is viewed in the context of a longitudinal cyclic process and may be further studied with specific pharmacologic agents that block drug-induced maniclike states in man.
Article and Author Information
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▸An edited transcription of a Combined Clinical Staff Conference at the Clinical Center, Bethesda, Maryland, 5 February 1976, by the National Institute of Mental Health, U.S. Department of Health, Education, and Welfare.
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▸Authors who wish to cite a section of this conference and specifically indicate its author can use this example for the form of reference:
WEHR TR: Phase and biorhythm studies of affective illness, pp. 321-324 in BUNNEY WE JR (moderator): The switch process in manic-depressive psychosis. Ann Intern Med 87:319-335, 1977
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▸Requests for reprints should be addressed to William E. Bunney, Jr., M.D.; Adult Psychiatry Branch, National Institute of Mental Health, Bldg. 10, Rm. 3N-212, National Institutes of Health; Bethesda, MD 20014.
