The "Switch Process" in Manic-Depressive Illness: I. A Systematic Study of Sequential Behavioral Changes

doi:10.1001/archpsyc.1972.01750270005001

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Vol. 27 No. 3, September 1972

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The "Switch Process" in Manic-Depressive Illness

I. A Systematic Study of Sequential Behavioral Changes

William E. Bunney, Jr., MD; Dennis L. Murphy, MD; Frederick K. Goodwin, MD; George F. Borge, MD

Arch Gen Psychiatry. 1972;27(3):295-302.

Abstract

This paper presents the first of a three-part report on behavioraland biological aspects of the "switch process" in a group ofmanicdepressive patients. It documents a regular temporal patternof change in thought and mood observed during ten spontaneousepisodes of switches from depression into mania and seven episodesof switches out of mania into depression. Patients were describedin detail and their behavior rated every eight hours on a longitudinalbasis throughout these periods of change. The depressive periodprior to the switch into mania was characterized by moderatedepression, seclusiveness, nonverbalization, and dozing. Eachof the ten episodes of mania was preceded by a normal or transitionalperiod which was manifested by sudden appearance of spontaneousspeech and motor activity and normalization of mood. Total sleeptime was markedly reduced on the day prior to the switch intomania and remained low during the manic period.

Author Affiliations

Bethesda, Md; Chicago

From the Section on Psychiatry, Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, Md (Drs. Bunney, Murphy, and Goodwin), and the Illinois State Psychiatric Institute, Chicago (Dr. Borge).

Footnotes

Accepted for publication Oct 29, 1971.

Reprint requests to Section on Psychiatry, Laboratory of ClinicalScience, NIMH, 9000 Rockville Pike, Bethesda, Md 20014 (Dr.Bunney).

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