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Clinical and Biological Correlates

Robert M. Post, MD; David R. Rubinow, MD; Thomas W. Uhde, MD; Peter P. Roy-Byrne, MD; Markku Linnoila, MD; Ann Rosoff, MA; Rex Cowdry, MD

Arch Gen Psychiatry. 1989;46(4):353-358.

Abstract
• Patients studied at peak severity of a manic episode showed substantial degrees of depression (dysphoria) and anxiety. Compared with nondysphoric manics (n = 26), the dysphoric manics (n = 22) had a significantly greater number of previous hospitalizations, and they displayed less rapid cycling both in the year before and during the index hospitalization admission. The severity of manic dysphoria tended to correlate with the number of previous hospitalizations, a finding that was highly significant in women (n = 27). Medication-free manic patients (n = 22) had significant elevations in cerebrospinal fluid norepinephrine concentrations compared with depressed and euthymic patients and normal volunteers, and the degree of elevation correlated significantly with the degree of manic dysphoria, anger, and anxiety rated at the time of the lumbar puncture. Patients with dysphoric mania, recognized by Kraepelin to have poor prognoses, have been reported to respond poorly to lithium carbonate but may be among those who respond to carbamazepine. Clinical, biologic, and pharmacologic response characteristics of manic subgroups, particularly those with extreme dysphoric components to their illness, appear to be clinically meaningful and deserving of further investigation.

Author Affiliations
From the Biological Psychiatry Branch (Drs Post, Rubinow, Uhde, and Roy Byrne and Ms Rosoff) and the Mental Health Intramural Research Program (Dr Cowdry), National Institute of Mental Health, and the Laboratory of Clinical Studies, National Institute on Alcohol Abuse and Alcoholism (Dr Linnoila), Bethesda, Md. Dr Roy-Byrne is now with the Department of Psychi atry, University of Washington, Seattle. Dr Cowdry is now with the Depart ment of Psychiatry, St Elizabeth's Hospital, Washington, DC.

Footnotes
Accepted for publication July 11, 1988.

Reprint requests to Biological Psychiatry Branch, NIMH, Bldg 10, Room 3N212, 9000 Rockville Pike, Bethesda, MD 20892 (Dr Post).

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