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mania (manic state)
Etiology:
1) bipolar I disorder
- manic episode may be 1st manifestation
2) pharmacologic causes:
a) glucocorticoids
b) levodopa
c) monoamine oxidase (MAO) inhibitors
d) sympathomimetics
e) tricyclic antidepressants
3) nitrate-cured meat products associated with mania in humans [5]
4) new onset in elderly
a) cerebrovascular disease
b) alcoholism
c) head injury
d) systemic lupus erythematosus
e) multiple sclerosis
5) frontal lobe syndrome [4]
Epidemiology:
- new onset mania uncommon in the elderly
Clinical manifestations:
1) hyperexcitability
2) euphoria
3) hyperactivity
4) generally present manifestations
a) rapid thinking & speaking
b) agitation
c) decreased need for sleep
d) marked increase in energy
e) grandiosity
f) increased goal-directed activity
g) impulsive behavior
h) increased sexual activity
i) aggression
5) occasionally present manifestations
a) hallucinations
b) delusions
Laboratory:
- urine drug screen
- amphetamines in urine
- cocaine in urine
- benzoylecgonine in urine
Differential diagnosis:
- in contrast to a manic episode, during a hypomanic episode, functioning is preserved well enough to function at work or socially & does not require hospitalization
Management:
1) lithium more effective than divalproex for treatment of mania in elderly [3]
2) see bipolar disorder
3) specific treatment for specific etiology
General
mood disorder
sign/symptom
References
- Harrison's Principles of Internal Medicine, 13th ed.
Companion Handbook, Isselbacher et al (eds), McGraw-Hill
Inc. NY, 1995, pg 829-39.
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004
- Young RC, Mulsant BH, Sajatovic M et al.
GERI-BD: A randomized double-blind controlled trial of lithium
and divalproex in the treatment of mania in older patients with
bipolar disorder.
Am J Psychiatry 2017 Aug 4
PMID: 29088928
http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2017.15050657
- Taylor JB, Prager LM, Quijije NV, Schaefer PM.
Case 21-2018: A 61-Year-Old Man with Grandiosity, Impulsivity,
and Decreased Sleep.
N Engl J Med 2018; 379:182-189. July 12, 2018
PMID: 29996076
https://www.nejm.org/doi/full/10.1056/NEJMcpc1712229
- Khambadkone SG, Cordner ZA, Dickerson F et al.
Nitrated meat products are associated with mania in humans and
altered behavior and brain gene expression in rats.
Mol Psychiatry 2018 Jul 18
PMID: 30022042
https://www.nature.com/articles/s41380-018-0105-6