Very-late Onset Mania Episode: Case Report and Review of Cases Over 75 Years of Age

Introduction: Bipolar I disorder typically characterized bycycles of depression and mania. Onset after the age of 75 yearsis very rare and the reported incidence of mania is 2/100000,which most often occur due to secondary organic aetiology.Here we are presenting a review and an interesting case oflate-onset first episode mania while evaluating and excludingall other secondary causes of mania.Case Report: 79-year-old male presented with 2 weeks’duration of illness and symptoms was suggestive of a manicepisode. The patient was thoroughly assessed with laboratoryinvestigations and non-contrast computerised tomography(NCCT) brain to find any secondary causes of mania butnothing was significant. Finally, as per tenth revision of theInternational Statistical Classification of Diseases (ICD-10)diagnosis of first episode Mania without psychotic symptoms(F30.1) was made. He was started on Valproate which wasgradually increased up to 750 mg/day and olanzapine 5mg.After 6 weeks, the YMRS score decreased from 32 to 8 and heachieved his premorbid functioning level.Conclusion: This case highlights that primary psychiatryillness can occur at any age but in the geriatric populationbefore finalizing the diagnosis all other secondary causesshould be ruled out. There is a high need for systematicresearch in this area to formulate effective managementguidelines in the geriatric population.

Secondary Mania after Postoperative Radiation Therapy for Primary Brain Tumor / 신경정신의학

Secondary mania associated with focal brain lesion has only rarely been reported. The authors report a case of secondary mania artier postoperative radiation therapy for primary brain tumor. Localized necrotic lesion was found in the right basotemporal lobe involving hippocampus, which might be the result of late delayed damage of the postoperative radiation therapy. This case suggests that secondary mania is closely related to focal, right basotemporal lesions. Knowing the relationship between the location of brain lesions and manic syndrome may be helpful to us In understanding the neuroanatomical and neurobiological mechanism of primary.