Hindawi Publishing Corporation Case Reports in Medicine Volume 2009, Article ID 286430, 3 pages doi:10.1155/2009/286430 Case Report Actigraphic Recording of Manic Symptoms Induced by Methylphenidate Tuuli Lahti,1 Sami Leppa¨ma¨ki,2 Pekka Tani,2 and Timo Partonen1 1 Department of Mental Health and Substance abuse Services, National Institute for Health and Welfare, 00271 Helsinki, Finland 2 Department of Psychiatry, Helsinki University Central Hospital, 00290 Helsinki, Finland Correspondence should be addressed to Tuuli Lahti, tuuli.lahti@thl.ﬁ Received 15 April 2009; Accepted 19 September 2009 Recommended by Tian Po Oei Objective. Attention-deﬁcit hyperactivity disorder (ADHD) is a developmental disorder characterized by a long-standing pattern of impulsive behavior, hyperkinesia, and inattention. Psychostimulants, for example, methylphenidate, are the treatment of choice for ADHD both in children, adolescents, and adults. Method. The eﬀect of methylphenidate on sleep structure is not well known. We studied the eﬀect of long-acting methylphenidate on sleep in adult ADHD patients, in a naturalistic treatment setting, using actigraphic and polysomnographic recordings. Results. One of our patients experienced manic episode after starting methylphenidate. A wrist-worn accelerometer recording demonstrated a decrease in the duration and quality of sleep. After discontinuation of methylphenidate treatment, the patient’s symptoms subsided and there was no need for hospital admission. Actigraphic recording showed a decrease in the amount and quality of the patient’s sleep as triggering factor for the manic symptoms. Conclusions. Disruptions of the sleep-wake cycle are probably important etiologic factors in mood disorders, especially bipolar disorder. The changes in length and quality of sleep described in this case report bear close resemblance to those of patients with a manic episode, although these symptoms were induced by methylphenidate. Copyright © 2009 Tuuli Lahti et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Introduction Attention-deﬁcit hyperactivity disorder (ADHD) is a devel- opmental disorder characterized by impulsive behavior, hyperkinesia and inattention. Recent studies suggest that there is a range of abnormalities in neurotransmission in ADHD patients [1]. Psychiatric comorbidity is common in adult ADHD patients [2]. In addition, other developmental disorders, for example, dyslexia, and sleep problems are frequent in patients with ADHD [3]. Severe ADHD symptoms are often treated with medic- ation. Psychostimulants are eﬀective in all symptom domains of ADHD. Stimulants such as dextroamphetamine and met- hylphenidate are used in the treatment of ADHD both in children and adults. A common adverse eﬀect of meth- ylphenidate is a sleep disturbance. In children, even short- acting methylphenidate thrice daily increases sleep onset latency [4]. However, in clinical experience, adult ADHD patients with prominently hyperactive symptoms in partic- ular appear to sleep better after a stimulant has been started. This in mind, we assessed the night-time sleep and the daily rest-activity cycles in adult ADHD patients before, during and after long-acting methylphenidate treatment (Concerta). One of the study participants, a 40-year-old man with no prior history of bipolar disorder, experienced a manic episode after the treatment with methylphenidate was started. His switch from euthymia into mania was recorded with a wrist-worn accelerometer. We present herein, for the ﬁrst time, actigraphic recording data on a switch from euthymia into mania induced by methylphenidate. 2. Methods The diagnosis of ADHD was assessed with the Conners’ Adult ADHD Diagnostic Interview for DSM-IV [5] using multiple sources of information. Mental disorders were excluded using SCID-I and SCID-II-interviews [6, 7]. A comprehensive neuropsychological test battery was included in the diagnostic process. At baseline, all the patients had a careful physical examination including laboratory tests and a urine screen. The study protocol was approved by the ethics committee of the Helsinki University Central