Studies of periodic catatonia — I: Blood levels of protein-bound iodine and urinary excretion of vanillyl-mandelic acid in relation to clinical course

Abstract

SINCE 1927 extensive sleep studies of patients with periodic catatonia have been carried out in this 1aboratory.l Sleep was recorded by means of a seismograph called ‘accelerograph Devik’. This apparatus records continuously all the patient’s movements while he is in bed. These studies concluded that all the patients with periodic catatonia had a moderate to severe sleep disturbance at the beginning or in the middle of their psychotic phases. The urinary catecholamine metabolites of several patients with periodic catatonia have been examined previously but not the catecholamines themselves. During the psychotic phase the excretions of both normetanephrine and metanephrine as well as 3-methoxy-4hydroxy-mandelic acid were all elevated.2-4 In order to examine the psychotic phase further, longitudinal EEG studies were carried out on three cases with periodic catatonia.5 These records showed a definite increase in alpha frequency and a decreased alpha amplitude during the active phase corresponding to the excretion of normetanephrine. Recently, extensive studies of sleep EEG in acute schizophrenic patients have been reported.6,7 Some actively psychotic patients showed unique changes in REM and other sleep parameters, compared with control subjects. Further intensive and systematic case studies are, however, necessary to determine whether or not the reported sleep disturbances are an inherent feature of acute psychotic exacerbations. In the present work, we have therefore extended our previous studies in examining the sleep EEG concomitantly with the urinary catecholamines in three cases of periodic catatonia. Sleep patterns and all the three urinary catecholamines were studied longitudinally over several months, covering one to three periods in each patient.