Edward A. Wolpert

NOCTURNAL SLEEP OF NARCOLEPTICS.

Abstract The EEG patterns and eye movements of nine narcoleptics during nocturnal sleep were compared with those of normals. Seven of the nine narcoleptics showed a distinctive phenomenon which is virtually unknown in other pathological conditions or in normals. The narcoleptics had stage 1 rapid eye movement (REM) periods at sleep onset rather than approximately 90 min after sleep onset as most subjects do. This was interpreted as suggesting that narcoleptics are susceptible to “precocious triggering” of the pontine reticular formation. Other manifestations of narcoleptic sleep which distinguished it from that of normals were: (1) a superabundance of body movements; (2) the presence of 9–11 c/sec activity in anterior EEG leads; (3) a tendancy to have less than a normal amount of large slow wave activity.

Intractable manic-depressive psychosis with rapid cycling in an 18-year-old woman successfully treated with electroconvulsive therapy

An adolescent patient with a history of progressively more severe seasonal depression subsequently developed a refractory manic-depressive psychosis with rapid cycling after the initiation of treatment with trimipramine. A complete remission was obtained after a course of six electroconvulsive therapy (ECT) treatments. This unusual case and its outcome are discussed in terms of apparent drug-induced rapid cycling and the treatment of this condition. It is suggested that ECT can be successfully used as an alternative therapeutic option for patients with intractable rapid-cycling manic-depressive disorder.

Manic-depressive illness in adolescence

The efficacy of lithium carbonate as a treatment for manic-depressive illness has stimulated a reevaluation of the syndrome. In this paper, the authors review the obstacles to timely diagnosis of manic-depressive illness in the adolescent. Three cases are presented demonstrating the usefulness of a unitary concept in which manic-depressive illness is understood and appreciated as having a physiologic basis, manifesting its effects in the total body system. The heterofore diverse and confusing psychological and behavioral symptoms of manic depressive illness in adolescents become intelligible when regarded as secondary phenomena: the psychic experience of the process as filtered through the psychological constitution of the individual adolescent.

Lithium Toxicity with Hypothyroidism as a Possible Determinant

A case of a woman with severe lithium toxicity and hypothyroidism with persistent hyponatremia and hypokalemia is presented. The mechanisms of the development of lithium toxicity by alterations in fluid and sodium metabolism, including those induced by lithium itself, are reviewed. The possibility that hypothyroidism may have been a significant determinant in the development of this case of lithium toxicity is considered and discussed. This is of special interest given that lithium can induce hypothyroidism. In addition, the safe reinstitution of lithium prophylaxis in this woman can be reported.

Coronary artery bypass in a patient on lithium carbonate prophylaxis.

What is thought to be the first case of coronary artery bypass in a patient on lithium carbonate prophylaxis is presented. A postcardiotomy delirium developed on day 2 and appeared unrelated to the underlying manic-depressive illness. A 2-year follow-up indicated apparent resolution of pre-existing psychological difficulties and no recurrence of somatic symptoms. It is suggested that lithium carbonate prophylaxis be continued with appropriate monitoring during coronary artery bypass procedures.

Functional Psychoses: Diagnostic and Prognostic Models.

In the present work, Drs. Astrup and Noreik present the results of a study designed to determine factors predictive of favorable or unfavorable resolutions of acute phychotic processes. The material studied includes 706 patients hospitalized at Gaustad Hospital, Oslo, from 1951 to 1957 who were available for follow-up at least five years later. Case histories—original anamneses and hospital courses—were coded by two psychiatrists, Dr. Astrup and one of several associates. Follow-up included personal examination where possible (at home, in hospital) or by questionnaire answered by patients, relatives, other hospitals, or public health officers. This series could be compared with a previous series of 1,102 patients admitted between 1938 and 1950. Eighteen clinical factors, 15 social factors, and various ways of looking at hereditary background were coded from the case histories. These factors were then differentiated by outcome conceived on a 5-point scale ranging from