Clinical and Biochemical Analysis of a Case of Manic-Depressive Psychosis Showing Regular Weekly Cycles
The patient under investigation, at the age of 51, became subject to a state of depression, which lasted for 14 years without complete remission. In 1942, at the age of 65, he developed weekly mental cycles in which he was in a depression for five days, followed by a manic state of two days. At first the mania appeared in the early part of the week, and gradually shifted to the week-end. When this investigation started the mania occurred every saturday and sunday, but lately it has appeared on Friday and Saturday. The transition from one phase to the other was characterized by a mixed state, showing both depressive and manic features. This patient belongs to a small group recognized by Kraepelin, which is characterized by the onset of depression in late middle age, changing in old age to a manic depressive cycle.

Closely correlated with his mental cycles are cyclic clinical and metabolic fluctuations. There was a definite rise in the bloodpressure, pulse and respiratory rates, during the manic phase, and a corresponding fall during the depression. The basal metabolism estimated for three weeks was found to be plus 30 in the mania and about minus 10 during the depression.

There was a gain of 2 to 3 lb. in weight during the depression, and a corresponding weight loss during the manic phase. There was a regular diminution of creatinine in the twenty-four-hourly urine passed in the period during which the transition from depression to mania occurred, although the urinary volumes on these days were the highest for the week.

The most marked fluctuations found were those in the water, chloride, and sodium output in the urine. The water excretion for the two days of mania amounted to nearly hail the weekly total, and the amounts of sodium and chloride were correspondingly high on these two days. There was, therefore, a cyclic metabolic fluctuation, which consisted of a retention of water and salt in the depressive phase, and a release of these in the manic phase. This means that the urinary constituents showing variation were probably derived from the extra cellular body fluid.

Furthermore, it appears that a sudden rise in the flow of the urine started when the patient was stillin his depression, and was maintaified at this high rate during the opening stages of his mania. By the time the patient had reached his most excited state this rate had already decreased. Also, there appeared to be no connection between the excessive output of the urinary constituents and the rise in blood pressure, pulse and respiratory rates during these transitions.

Further investigations on this case are in process, and the results of these will be published later.