Secondary Mania in Older Adults

• DOI: 10.1176/appi.ajp.162.11.2033
• Publication Date: 2005-11-01T15:47:49Z
• Authors: John O. Brooks; Jennifer C. Hoblyn
• Keywords: Male; Bipolar Disorder; Brain Neoplasms; Age Factors; Middle Aged; Magnetic Resonance Imaging; Psychoses, Substance-Induced; Anti-Bacterial Agents; Diagnosis, Differential; 03 medical and health sciences; 0302 clinical medicine; Clarithromycin; Humans; Dementia; Female; Aged; Antipsychotic Agents

Although mania is commonly associated with bipolar disorder, it can have many etiologies (1). Thus, “primary mania” results from bipolar disorder, whereas “secondary mania” results from pharmacological, metabolic, or neurologic causes (1, 2). Older adults are at risk for secondary mania because of increased medical comorbidities and neurological changes. In one retrospective study of 50 patients with mania who were older than 65 years, it was the first manic episode for 28% of the patients and 71% had a comorbid neurological disorder (3). The etiology of mania is important because although acute symptomatic treatment of both primary and secondary mania may be similar, appropriate treatment of secondary mania includes addressing the cause (1). We present here two case histories of secondary mania in older adults, discuss their presentations and differential diagnosis in turn, and discuss treatment.