Organic Causes of Mania
Section snippets
CLINICAL FEATURES
The diagnostic features of a manic episode are described in Table 1, as condensed from the Diagnostic and Statistical Manual of Mental Disorders—third edition, revised (DSM-III-R).2 The cardinal symptom is an abnormally and persistently elevated or irritable mood, and at least three of the associated symptoms or signs must accompany the mood disturbance. The pronounced increase in energy, impaired judgment, grandiosity, and flight of ideas often lead patients to sexual indiscretions, buying
PATHOPHYSIOLOGY
Organic lesions associated with manic syndromes involve the areas of the brain that modulate neurovegetative functions (such as sleep, appetite, libido, and energy) and emotion.4 These areas include the limbic system, thalamus, and hypothalamus, together with their connections to the midbrain, basal ganglia, and frontal and temporal lobes.5 Right-sided lesions have been reported more frequently in patients with organic mania, but left-sided and diffuse lesions have also been reported.3 In a
Method of Identification.
We conducted a MEDLINE search for all English-language references published from 1965 through 1987 in which organic or medical conditions were associated with mania. Further references dating back to 1892 were gathered from the articles cited in MEDLINE. The organic conditions listed as being associated with mania (Table 3) were compiled from cases that were judged to meet the DSM-III-R criteria for organic mood syndrome, manic type. In cases of multiple references to the same conditions or
DISTINCTION BETWEEN ORGANIC AND IDIOPATHIC MANIA
Idiopathic bipolar disorder should be diagnosed only after all organic causes have been ruled out. This can be difficult when mania is the solitary initial symptom, as in the aforementioned cases of Huntington's chorea,25 herpes simplex encephalitis,34 and cryptococcal meningoencephalitis.35 In most cases cited, however, other neurologic abnormalities (delirium, dementia, unilateral motor or sensory deficits, or cranial nerve palsies) were present as well. Anosognosia and unilateral neglect
EVALUATION AND TREATMENT
Organic mania can be clinically identical to idiopathic bipolar disorder and may respond similarly to lithium (see subsequent material). Therefore, all patients who have first-onset mania should undergo the following assessment: (1) careful elicitation of the history regarding current medical symptoms, recent infections, use of medications or drugs of abuse, and past history and family history of psychiatric disorders; (2) complete medical examination, in conjunction with a neurologic
ACKNOWLEDGMENT
We thank Carol L. Cooper for secretarial assistance.
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