Secondary Mania

Antidepressant‐associated mania in late life

“…When comparing findings of this study with conflicting reports in younger patients, both the nature of the patients and differences in study designs need to be considered. The observed association of AAM in elders with first episode of mania and late age at onset of first mania is congruent with reports concerning manic states in which provocative medical factors are implicated (Krauthammer and Klerman, 1978;Black et al, 1988), and with occurrence of mania (n ¼ 7) at a mean age of 63 years among unipolar patients (n ¼ 50) with a mean age of 53 years who were being treated with tricyclic antidepressants with or without convulsive therapy (van Sheyen and van Kammen, 1979). These findings contrast with an association noted between greater number of prior manic episodes and AAM in younger bipolar patients (Boerlin et al, 1998) and a report of relatively early age at illness onset among younger bipolar AAM patients (Nasrallah et al, 1982); in other reports in younger bipolar patients there was no association between AAM and number of episodes (Henry et al, 2001), and neither AAM nor antidepressant-associated hypomania were linked to age at onset (Altshuler et al, 1995;Boerlin et al, 1998;Henry et al, 2001).…”

Age, manic psychopathology and treatment response

“…Manic syndromes and bipolar disorders with later age at onset may have different aetiologies and pathophysiologies compared to those with earlier age at onset. Such patients have less prevalent family history of affective illness (Shulman and Post, 1980) and may more often be associated with 'organic' aetiologic factors (Krauthammer and Klerman, 1978) and coarse brain changes (Shulman and Post, 1980). The findings concerning drug treatment response in this sample are consistent with descriptions of prolonged time required to regain insight in elderly patients (Post, 1982).…”

Polymicrogyria: An Unusual Case of Secondary Mania

“…Also, in patients with known bipolar or schizoaffective disorder, brain injuries could precipitate, exacerbate, and/or prolong manic episodes, worsening the course of the primary psychiatric disorder. 5,9 Thus, even when a causal relationship to mania cannot be completely established, the case presented here fulfills all of the diagnostic criteria for secondary mania proposed by Krauthammer and Klerman, 3 except for late-onset. To our knowledge, this is the first report of secondary mania related to polymicrogyria, and therefore we provide a more extensive discussion below.…”

“…Thus, even when a causal relationship to mania cannot be completely established, the case presented here fulfills all of the diagnostic criteria for secondary mania proposed by Krauthammer and Klerman, 3 except for late-onset. To our knowledge, this is the first report of secondary mania related to polymicrogyria, and therefore we provide a more extensive discussion below.…”