Bipolar disorder and cerebral sarcoidosis
Article Abstract:
Sarcoidosis is a systemic disorder that affects the nervous system infrequently; but when it does, involvement usually occurs early on in the course of illness. Cerebral sarcoidosis tends to have a relapsing and remitting course involving granular, firm lesions, and nodes that can affect the spinal cord, cerebellum, or cerebral hemispheres, and can infiltrate the pituitary, third ventricle, thalamus, and other surrounding areas of the limbic system. The case report is presented of a 40 year-old Irish, married man with three children, suffering from both neurological and hormonal complications of cerebral sarcoidosis. Sarcoidosis was first diagnosed at age 25, when he was treated for inflamed lymph nodes. At age 34, damage to peripheral and bilateral fifth cranial nerves resulted in leg muscle weakness, facial numbness, and impaired eyesight. Two years later he developed diabetes insipidus and anterior pituitary failure requiring hormone replacement therapy. At age 38 he became depressed, had symptoms of anorexia, and exhibited marked short-term memory loss. An antidepressant relieved some depressive symptoms, but did not improve his memory. One year later he began to have mood swings. When he began alternating between mania and severe depression, indicating bipolar affective disorder, he was hospitalized. After six weeks of treatment with low doses of lithium manic symptoms improved, and after another three weeks, the depression began to subside. The patient was discharged, but memory impairment persisted. Three months later he became seriously depressed, and after several suicide attempts, he took an overdose of antidepressants and died. Autopsy revealed a large granulomatous mass infiltrating his limbic system. Previous reports (e.g., in Korsakoff's syndrome) have implicated thalamic lesions in amnesic syndrome, which may explain this patient's memory loss. Since his emotional lability was also thought to derive from sarcoid involvement of the limbic system, it is posited that there may be a causal relationship between limbic system damage and bipolar affective disorder. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Psychiatry
Subject: Health
ISSN: 0007-1250
Year: 1991
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Money hidden and rediscovered in subsequent manic phases: a case of action dependent on mood state?
Article Abstract:
The association between memory and mood has long been investigated. Data have repeatedly suggested that memory for information learned during one mood-state is best remembered when that mood-state is present. For instance, in one study manic-depressive patients were able to remember 97 percent more of the word associations they made while in a manic state when retested in another manic state than when they were retested in a normal (i.e. nonmanic) state. In the present case, a 42-year-old man was admitted to the hospital for what seemed to be a hypomanic state of argumentiveness, overactivity, and irritability, among other symptoms. He responded quickly to medication and was released for outpatient care. Prior to hospitalization, the patient had withdrawn money (3,000 pounds Sterling) from his bank account and had hidden it with no recollection of where it was. Six months after discharge it remained lost. About that time, the patient stopped taking his medication and he relapsed. In an effort to hide something else, he found the money hidden behind a painting. It is not thought that this is an example of state-dependent memory because there is no evidence that the patient actually remembered where he had hidden the money before happening upon it. In fact, to this day he has no recollection of having hidden it there. It is suggested, however, that this case provides evidence of state-dependent action, rather than memory, because again in a manic state, the patient thought of hiding something in the same unusual place as he had hidden the money. The actions leading him to think of and use this hiding place were duplicated in the subsequent manic state. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Psychiatry
Subject: Health
ISSN: 0007-1250
Year: 1991
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Familial manic-depressive illness with deleted short arm of chromosome 21: coincidental or causal?
Article Abstract:
With the exception of the male and female reproductive cells, human cells contain 46 chromosomes, each consisting of different DNA molecules and different sets of genes. The role of genetic factors in mood disorders has been implicated in family, twin, adoption, and biochemical studies. Inherited defects of chromosome-21 are common, but are often benign. The case report is presented of a 35-year-old Arab woman with recurrent manic-depressive episodes for whom chromosome analysis of peripheral blood cultures revealed a defect on chromosome 21. The woman had an 18-year history of hospitalizations in Europe and the US. The patient's mother also had he identical chromosome defect and a long history of manic-depressive disorder. Both woman also had histories of menstrual disturbances and excessive growth of facial and body hair. The patient's six siblings had not demonstrated any signs of mental disorder, and refused to submit blood for testing. A better understanding of the relationship between chromosomal abnormalities and human behavior may benefit psychiatric patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Psychiatry
Subject: Health
ISSN: 0007-1250
Year: 1989
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