Elsevier

Mayo Clinic Proceedings

Volume 63, Issue 9, September 1988, Pages 906-912
Mayo Clinic Proceedings

Organic Causes of Mania

https://doi.org/10.1016/S0025-6196(12)62694-9Get rights and content

Manic syndromes have many neurologic, toxic, and metabolic causes. It is important for clinicians to be able to distinguish these organic disorders from primary idiopathic mania (bipolar disorder). The cardinal symptom of organic mania is an abnormally and persistently elevated or irritable mood. Organic mania usually develops in patients who are older than 35 years of age, whereas bipolar disorder generally has its onset between late adolescence and age 25 years. In patients with the first episode of mania, the clinician should thoroughly elicit information about current symptoms, recent infections, use of drugs, and past or family history of psychiatric disorders. In addition, a complete medical examination, computed tomography of the head, electroencephalography, and screening for drugs and toxins should be done. Treatment of organic mania includes correcting the underlying disorder when possible.

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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