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.

A Suspected Case of MEHMO – Rare X-linked Mitochondrial Disorder

Introduction: MEHMO (Mental retardation, epilepticseizures, hypogonadism and hypogenitalism, microcephalyand obesity) is a rare and complex X-linked disorder whichcharacterized by profound intellectual disability, epilepticseizures, hypogonadism and hypogenitalism, microcephalyand obesity. By genetic haplotype and linkage analysis,disease locus has been assigned to Xp21.1 - Xp22.13.Case report: The patient was born to non-consanguineousparents near the term of delivery and clinically was verysimilar to the syndromal description of MEHMO. Familyhistory of deaths of 2 maternal uncles below the age of 2 yearssuggests X- linked inheritance.Conclusion: The findings of index case warrant cliniciansto be more vigilant while assessing such cases and calls forthorough clinical examination, family history, detailed labwork up and molecular genetics whenever possible to supportand contribute towards literature in futur