Longitudinal study of periodic catatonia. Long-term clinical and biochemical study of a woman with periodic catatonia.

A woman with periodic catatonia had a 600-day metabolic study. The results were analyzed by harmonic analysis. Her periodic stupors showed a regular 36-day rhythm apparently related to a 24-day menstrual cycle; but the rhythm persisted when menstrual function was blocked by continuous Enovid (norethynodrel + mestranol) administration. During the menstrual block, weight, sodium balance, magnesium and 17-ketosteroid (17-KS) excretion gave indications of 12- and 36-day fluctuations. Further studies on steriod excretion indicated that similar fuctuations in 17-KS output occurred when the patient was menstruating normally. The peaks of the 12-day cycle coincided with menses and the mid-menstrual phase; while the peak of the 36-day cycle coincided with the onset of stupor. 17-hydroxycorticosteroid (17-OHCS) excretion had a 36-day cycle which lagged 4 days behind the 36-day 17-KS cycle. There were no indications of a 12-day 17-OHCS cycle. In the discussion it is suggested that the 17-KS fluctuations may partly reflect gonadotrophin activity rather than being exclusively due to ACTH. It is noted that Enovid may block only LH activity not total gonadotrophins. It is speculated that there may be a relationship between gonadotrophin activity and the psychic disturbance.