Individualized Stress Vulnerabilities in Manic Depressive Patients with Repeated Episodes

This paper reports on an observation made in the course of the authors’ investigations into the connection between life events and mania. Briefcase summaries are given where repeated relapses in the same patient appeared to focus around a theme or meaning which is specific for each patient, yet quite different across patients. The therapeutic implications of such individualized vulnerabilities are discussed.

Periodic menstruation-linked psychosis of adolescence

Clinical reports of a psychosis with distinct presentation affecting adolescent girls have appeared sporadically over more than a century, but its specificity has not been fully recognized. The literature is briefly reviewed and our experience with 11 such patients is presented. Periodic Menstruation-Linked Psychosis of Adolescence (PMLPA) appears to have a clinical picture which differs from that of any other form of psychosis, and to respond to different therapeutic regimes being at the same time totally unresponsive to traditional antipsychotic drugs. This makes the syndrome distinct, specific and highly treatable and therefore its recognition is of considerable clinical importance.

Preschizophrenics: adding to the evidence, sharpening the focus

The notion of a subclinical preschizophrenic condition already present in childhood is given further support by the findings of this follow-back study, which also brings into sharper focus the childhood profile of the likely adult schizophrenic.

Causable mania (reactive, puerperal, secondary, life event related). The development of an idea

This paper reviews the development of the concept of non-endogenous mania from myth to psychiatry and on to today. The varieties of causable mania are examined and an attempt is made to bring together the evidence which has been growing in the last few years from research in various different areas. As a result, a bridge appears between organic and psychoanalytical conceptualizations of mania, which may have important consequences for the management of manic patients in the future. Mania emerges as part of the depressive process rather than as its opposite.

Life events and mania. A special relationship?

Fifty patients in their first manic episode were compared retrospectively with groups of (a) manic patients in other than first admissions and (b) acute surgical cases. They were then followed up for 3-8 years. First manic admissions were linked to life events far more frequently--66% vs 20% and 8% respectively for the other groups. Within-group comparisons showed patients with life events were much younger. The link between life events and manic episodes appeared immediate and selective, a view further supported by the findings of the follow-up. Later episodes precipitated by life events seem to require smaller amounts of stress. The possible role of life events in relation to mania is discussed.

Predictability of course of illness in manic patients positive for life events

The intention of this study was to examine the possibility of predicting course of illness in manic patients, using a stress variable as a predictor, together with other more traditional indices. On the basis of information on three easily available parameters--family history, age at onset, and stress intensity--20 manic patients who had independent life events preceding an index admission were allocated into various risk groups and predictions were then made with regard to future course of illness for 5 years. On follow-up, the predictions were found to be correct in 85% of cases overall, and two high-risk factors were totally predictive.

Psychologically stressful events in the precipitation of manic episodes

The case notes of all 67 manic patients admitted to the psychiatric wing of a District General Hospital over a period of two years were screened for evidence of independent life events during a four week period prior to admission. The nature of such events and of the underlying stresses was examined and the data obtained were compared with data from a control group of acute surgical admissions. Four times as many manic patients had an independent life event closely preceding their admission. It is concluded that stress in the form of loss or threat is a common precipitant of mania. Some surprising findings are focused upon and discussed.