Vascular correlates of circular type manic-depressive disorder.

An ambulant patient with a regular series of mood changes constantly varying between retarded depression and hypomania on a 32- to 36-day cycle was studied for 39 weeks. The patient completed a daily self-assessment of the 11-point Dorland mood scale each evening. This scale encompasses a range of moods varying from depression through euthymia to mania. Weekly recordings each lasting 65 min were made of resting heart rate, 14 parameters derived from electrical impedance plethysmography of the head together with arterial blood pressures before and after each recording. Results were correlated with the changing mood scores. Time series analysis of the mood scores yielded a recurrent mood cycle of 35 days unchanged by such drug treatments as had been prescribed by the psychiatrist. The mood score correlated positively with the impedance amplitude, inflow angle, and transit times, and negatively with percent rise time, heart rate, and blood pressures. Amplitudes, rise times, and CT2 were independent of heart rate and blood pressures and hence probably related more closely to cerebral blood flow.

Carotid-vertebral artery blood transit time: results in healthy subjects and patients with schizophrenia and brain disease.

Estimation of blood transit time in the neck and the extension of this into the head was made by a method of electrical impedance, over a wide age range, in 159 healthy subjects, 160 schizophrenic patients, and 199 patients with organic brain disease. In each case, the distance between the electrocardiogram and the next succeeding pulse-volume impedance wave was measured and averaged over 30 serial wave forms. Chronological age proved a significant variable, transit times lengthening progressively with the age, but only for measurements extending into the head. Sex and hemispheric laterality played no significant role. With age held constant, mean transit times into the head were significantly prolonged in both groups of patients as compared with controls. No significant differences were found however between means of psychiatric andneurological patients. It is suggested that these results reinforce the organic etiology of schizophrenia.

Spontaneous rhythms of perceptual motor performance in intact and damaged brain of man.

A simple 15-sec maximal speed tapping task was administered every minute for 20 min to 69 healthy subjects and to 53 patients with mental disorders embodying six diagnostic categories including mental retardation. Analysis of the results showed age and diagnosis, but not gender, to be significant variables. Autocorrelation analysis of the results revealed the existence of spontaneous ultradian cycles of recurrence for all subjects, the frequency and amplitude of which discriminated the healthy subjects and only non-organically sick patients from patients with organic neurological deficits. 'Scatter' scores representing deviations about the mean tapping scores showed similar cyclic characteristics. The relationship between these cycles of motor performance and neural clock controlling perception is discussed.

Characteristics of a neural clock regulating perception and psychomotor performance in man.

A biological clock regulating some psychomotor aspects of perception has been adduced from the results of the repetitive administration of a maximal speed tapping test of 15 sec per hand per min for a total of 20 min. 412 longitudinal timed tests from 8 healthy control subjects, 4 physically healthy and 6 brain damaged psychiatric patients formed the basis for the investigation of the properties of this clock. It was found that this perceptual clock is endogenous, self-sustaining and innate. Its free-running oscillations are independent of psychic state, emotions and affect. They are, however, dependent upon the subject's neural integrity and their phase may be influenced by an orientating reflex. Timing is precise but the preceding phase may influence a succeeding one. Despite the muscular activity of the task the clock is relatively independent of body temperature. It is also immune to most psychoactive drugs.

Periodic homeostatic fluctuations of skin temperature in the sleeping and waking state.

53 healthly persons were monitored for skin temperature by a Hardy dermal radiometer every 60 sec. Readings continued until a spontaneous cycle appeared. 32 subjects were examined awake and 21 while asleep. A spontaneous rhythm with a mean of 4.25 min was found for the awake subjects, and one of 8.33 for the asleep subjects. To confirm these findings longer recordings were made by a thermocouple electronic thermometer in a further 23 subjects. Observations were continued until the awake subject slept. The results were analyzed by autocorrelation. In 13 records the sleeping rhythm was significantly longer than the waking. Another thermocouple probe in 14 subjects was used to measure axillary temperature. In 7 subjects a shorter cycle was seen while awake and a longer one while they slept. The properties of a perceptual clock are reviewed. It is suggested that the relative awareness of the subject be added to them.

A free-running endogenous rhythm of the resting heart rate in man.

A sine-wave oscillating rhythm of the heart rate is reported in 24 out of 31 resting healthy subjects. Identification of these free-running cycles was by spectral analysis of minute-by-minute recordings of electrocardiograms, and in a few cases by inspection of cardiotachometer records. The periodicity of this rhythm was circa 10 min and was intermediate in frequency between the rapid fluctuations with frequencies of 15, 30, and 60 s and those of a frequency recurrent every 90 min already described in the literature. Our cycles were independent of age and sex.

Carotid-vertebral artery blood transit time in health and in neurological patients: a preliminary study by a non-invasive impedance method.

Thirty-one healthy subjects and nineteen neurological patients covering a range of chronic neurological and neurovascular syndromes were examined by an electrical impedance method. Two estimates of carotid-vertebral artery transit times were measured: one time taken between the Q wave of the EKG to the commencement of the next succeeding impedance pulse-volume wave (CT1), and the other, this estimate together with the time to maximum point of the impedance wave (CT2). Results indicated prolonged circulation times for the patients as compared with the controls without relevance to age in the case of CT1, although transit times did increase with age for CT2. It is suggested that this impedance technique may be valuable in the initial screening of transient cerebral ischaemia.

Sinus tachycardia and abnormal cardiac rate variation in schizophrenia.

The sinus rhythm resting heart rates of 138 schizophrenic patients were monitored electrocardiographically each for 30 min and were compared with those of 139 healthy controls. It was found that a significant sinus tachycardia existed in the patients. Factors of chronologic age, sex and treatment by psychotropic drugs were non-significant. A subsample of 22 process schizophrenic patients was compared with 20 healthy controls, matched for age, monitored continuously for a minimum of 120 min and analyzed by autocorrelation on a minute-by-minute basis for cardiac rate variation. Ultradian rhythms of each group revealed that the periodicity of cardiac rate variation in schizophrenia was significantly longer than that in health. Treatment by psychotropic drugs in half of the patient sample did not appear to influence the cardiac rate variation. It is suggested that the bradycardia existing between pulses of tachycardia in schizophrenia may be responsible not only for the dysplastic perception of these patients, but also for their premature death from vascular causes.

Two biological rhythms of perception distinguishing between intact and relatively damaged brain function in man.

A simple test of perception, the Critical Flicker Fusion threshold (CFF) was given successively for 20 mins. to 69 healthy subjects aged 7-63 and to 53 comparable neuropsychiatric patients. The latter could be divided into a functionally sick group and a group with brain damage. Auto-correlation analysis revealed significant sine-wave cycles of amplitude and ultradian frequency for the CFF mean scores and the CFF "Scatter* scores. Both cycles of recurrence showed frequencies which distinguished significantly between the total healthy subjects and the patients. Further analysis showed no difference between controls and emotionally sick patients (i.e. those with sociopathy, schizophrenia and manic depressive psychosis) but there was a highly significant difference between these three groups and patients with relatively damaged C.N.S. (i.e. those with mental deficiency, organic brain syndrome and organic dementia). Even among the control group a progressive increase in frequency of these perceptual cycles occurred with advancing age. These CFF results point to the existence of a cycle of perceptual acuity and another of vigilance in the organism. Both appear to relate to the neural integrity of the C.N.S.

Cerebral circulation and EEG alpha frequency in relation to daily fluctuations in psychotic behavior.

Aspects of the cerebral circulation were monitored daily by cerebral electrical impedance plethysmography in one chronic schizophrenic girl for 9 months and seven other chronic schizophrenic patients for a period of 8 months. An additional manic-depressive patient was monitored while in a remission phase over 2 months. Simultaneous electroencephalogram (EEG) recordings were made on the schizophrenic patients. Daily Malamud-Sands (MS) psychiatric rating scales were completed by trained nursing staff on all patients. Correlation coefficients were obtained between this behavioral variable and the EEG-measured alpha frequency. Correlations were also run between the dimensions of the MS rating scale and three indices of the cerebral circulation and between two indices of cervical blood flow. Results indicated significant correlations between the "stuporous" scores of the MS scale and the cerebrovascular measurements in one catatonic patient. EEG alpha frequency correlated significantly with "excitement" scores in the same patient. The manic-depressive patient monitored in her remission phase showed no correlations with MS scores but relatively unchanging normal cerebral hemodynamics. The remaining seven chronic schizophrenic patients were followed daily for 8 months during a drug regimen in which phenelzine and L-tryptophan were administered. Significant relationships were found between the daily fluctuations of behavior and cerebral circulatory variables in a majority of the patients, and the extent of these correlations appeared to be increased by the addition of the metabolically active agents. Only a minority of correlations between MS scores and EEG dominant frequency were found in this group of patients. It is concluded that the MS scale affords a useful ethological monitor of psychotic behavior and that cerebral electrical impedance plethysmography and EEG alpha frequency correlate significantly with the fluctuations it records.

Repeated sleep deprivation as a therapeutic Zeitgeber for circular type manic depressive disturbance.

A post-menopausal woman suffering from a circular type manic depressive psychosis who had been treated by drugs was followed for 8 months on a self-reporting mood rating scale. The drug regimen was continued over a further 8 months but with the addition of 5 nights of sleep deprivation at the depth of her recurrent depressed moods. Time series analyses of the subject's longitudinal mood scores revealed a persistent cycle of 32 days. After 5 sleep deprivation treatments this cycle shortened to 28 days which endured at least for the ensuing 8 months. After sleep deprivation and decrease of the amplitude, an improvement of mood was obtained. It is suggested that the increased LD ratio obtained in sleep deprivation may be as therapeutic as the actual loss of sleep itself.

The diagnostic potential of rheoencephalography in psychiatry.

A 33 electrode monopolar rheoencephalograph was employed to produce a 15 min record of electrical impedance plethysmographic pulse-volume waves in 139 healthy sujects and 782 patients belonging to 15 psychiatric syndromes. Parameters of amplitude, percent rise time and average inflow angle were hand-measured and their means obtained for 30 waveforms throughout each record. Results obtained depended significantly upon chronological age and in some cases on gender. Mental health was found clearly distinguishable from psychiatric disability, but psychiatric syndromes could not be differentiated from one another. A low percent rise time coupled with a high average inflow angle were typical of youth and mental health.

Comparison between some biological clocks regulating sensory and psychomotor aspects of perception in man.

Regular repetition of one monitor of sensory perception and another of psychomotor perception revealed similar frequency and amplitude aspects of spontaneous endogenous free-running cycles of perception and others of vigilance. The ultradian periodicities of these cycles distinguish between persons with intact nervous systems and those with brain damage.

Vascular pacemakers of mood in manic depressive psychosis.

A daily longitudinal study enduring for more than two years was made of an ambulance patient whose mood changed predictably every 35 days from a profound retarded depression through euthymia up to hypomania and back to depression. The patient employed a self-reporting bipolar mood scale for this study. Weekly hour-long recordings of aspects of her vascular system were made of her electrocardiography, arterial pressures and electrical impedance plethysmography. Correlations were sought between mood scores and these physiological changes. Time series analysis of her auto-cross-correlograms indicated that the vascular elements preceded the mood change in a predictable sequence. Heart rate and percent rise time had the shortest cycles and were the earliest indices of change; amplitude and inflow angle, the next; while arterial pressures were the slowest. The genesis of mood change as an impedance function of the relationship of neurotransmitter to cerebral microvasculature is discussed.

An ultradian rhythm of reaction time measurements in man.

Repeated measurements of reaction times were made individually in 53 healthy subjects at 60-sec intervals and continued for 30 min. The subject's visual perceptual task each minute was to determine the momentary cessation of the second hand of a clock and his reaction times were automatically recorded. The results showed that the subject's reaction times followed a free-running cycle ranging in frequency between 4 and 15 min when their reaction times were submitted to spectral analysis and autocorrelograms obtained. Error scores during the procedure showed significant correlations with chronological age but not with gender. The biological implications of these oscillations are discussed.

Enduring effects of modified ECT on the cerebral circulation in man. A computerized study by cerebral impedance plethysmography.

The response of the cerebral circulation to modified ECT was monitored by computer programmes in 18 psychotic patients using cerebral impedance plethysmography. Each patient was recorded daily prior to, during and following the course of ECT. Results indicated that ECT was accompanied after 2 h by a marked increase in cerebral blood flow (CBF) in depressed patients; the schizophrenics showed a decrease in CBF. Patients whose blood flow had improved tended to return to previous levels progressively during the first week.