Recovery from neuroendocrinological abnormalities and frontal hypoperfusion after remission in a case with rapid cycling bipolar disorder

• Published in: Psychiatry and clinical neurosciences 1997-08, Vol.51 (4), p.207-212
• Main Authors: SHIMIZU, EIJI, KODAMA, KAZUHIKO, SAKAMOTO, TADASHI, KOMATSU, NAOYA, YAMANOUCHI, NAOTO, OKALIA, SHIN‐ICHI, SATO, TOSHIO
• Format: Article
• Language: English
• Subjects: Anticonvulsants - administration & dosage; Biological and medical sciences; bipolar disorder; Bipolar Disorder - diagnosis; Bipolar Disorder - drug therapy; Bipolar Disorder - physiopathology; Carbamazepine - administration & dosage; clonazepam; Clonazepam - administration & dosage; Dexamethasone; dexamethasone suppression test; Drug Therapy, Combination; Female; Frontal Lobe - blood supply; Humans; Hydrocortisone - blood; hypothyroidism; Hypothyroidism - diagnosis; Hypothyroidism - drug therapy; Hypothyroidism - physiopathology; Medical sciences; Middle Aged; Neuropharmacology; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; rapid cycling affective disorder; Regional Blood Flow - physiology; single photon emission computed tomography; Thyroid Function Tests; Thyroid Hormones - blood; Thyrotropin - blood; Thyrotropin-Releasing Hormone; Tomography, Emission-Computed, Single-Photon
• ISSN: 1323-1316; 1440-1819
• DOI: 10.1111/j.1440-1819.1997.tb02584.x

A 51‐year‐old Japanese woman who had been suffering from a rapid cycling affective disorder (RCAD) for 24 years responded to combined clonazepam and carbamazepine therapy. Before remission, she showed neuroendocrinological and neuroimaging abnormalities such as subclinical hypothyroidism with exaggerated response to thyrotropin releasing hormone (TRH) injection, non‐suppression on the dexamethasone suppression test (DST) and hypofrontality in cerebral blood flow. Her symptoms improved remarkably soon after adjunctive clonazepam treatment. After remission, her biological markers gradually returned to normal. First, subclinical hypothyroidism improved 2 months after remission. Next, hypofrontality disappeared 18 months later. Furthermore, non‐suppression on the DST normalized 24 months later. The normalization of biologcal markers with apparent recovery from RCAD suggests a decreased risk of relapse into mood disorder. These findings reiterate the importance of following‐up on the biological markers in RCAD for years after remission.