Secondary mania after open-heart surgery

Right-sided brain lesions predominate among patients with lesional mania: evidence from a systematic review and pooled lesion analysis

Despite claims that lesional mania is associated with right-hemisphere lesions, supporting evidence is scarce, and association with specific brain areas has not been demonstrated. Here, we aimed to test whether focal brain lesions in lesional mania are more often right- than left-sided, and if lesions converge on areas relevant to mood regulation. We thus performed a systematic literature search (PROSPERO registration CRD42016053675) on PubMed and Web-Of-Science, using terms that reflect diagnoses and structures of interest, as well as lesional mechanisms. Two researchers reviewed the articles separately according to PRISMA Guidelines, selecting reports of adult-onset hypomania, mania or mixed state following a focal brain lesion, for pooled-analyses of individual patient data. Eligible lesion images were manually traced onto the corresponding MNI space slices, and lesion topography analyzed using standard brain atlases. Using this approach, data from 211 lesional mania patients was extracted from 114 reports. Among 201 cases with focal lesions, more patients had lesions involving exclusively the right (60.7%) than exclusively the left (11.4%) hemisphere. In further analyses of 56 eligible lesion images, while findings should be considered cautiously given the potential for selection bias of published lesion images, right-sided predominance of lesions was confirmed across multiple brain regions, including the temporal lobe, fusiform gyrus and thalamus. These, and several frontal lobe areas, were also identified as preferential lesion sites in comparisons with control lesions. Such pooled-analyses, based on the most comprehensive dataset of lesional mania available to date, confirm a preferential association with right-hemisphere lesions, while suggesting that several brain areas/circuits, relevant to mood regulation, are most frequently affected.

The co-occurrence of mania with medical and other psychiatric disorders

OBJECTIVE

The co-occurrence of mania with other medical and psychiatric disorders has been little studied. The authors reviewed the literature in order to clarify the current state of knowledge of this subject and to identify possible areas of future research.

METHODS

Published articles which specifically addressed associations of mania with medical disorders and other psychiatric syndromes were identified using the Paperchase medical literature search system and by cross-referencing from other published work. The articles were then organized into three categories: 1) medical disorders associated with secondary mania; 2) medical comorbidity in bipolar disorder; and 3) psychiatric comorbidity in bipolar disorder.

RESULTS

The review of medical illness and secondary mania supports the hypothesis that injuries involving right-side and mid-line brain structures are associated with so-called secondary mania. Additionally, an association between bipolar disorder and migraine is identified. Several psychiatric disorders appear to occur with mania at rates higher than expected including obsessive-compulsive disorder, bulimia nervosa, panic disorder, impulse control disorders, and substance abuse.

CONCLUSIONS

The authors discuss the potential implications of these findings and suggest research approaches to further examine the relationships between mania and other medical and psychiatric syndromes.

Disinhibition syndromes, secondary mania and bipolar disorder in old age

BACKGROUND

The neurological literature concerning disinhibition syndromes and secondary mania has run in parallel to clinical reports of bipolar disorder in old age.

METHODS

A critical review was conducted of both the neurological and geriatric psychiatry literature in an attempt to integrate the two streams.

RESULTS

Disinhibition syndromes include lateralization to the right hemisphere and localization of lesions to the orbito-frontal and basotemporal cortex involving limbic and frontal connections (orbito-frontal circuit). Mania in old age is associated with late onset, heterogeneous neurological disorders and poor outcome.

CONCLUSION

Bipolar disorders in old age may be understood in the context of affective vulnerability influenced by a specific neurobiologic substrate.

LIMITATIONS

The clinical literature consists predominantly of small case series and anecdotal reports.

CLINICAL RELEVANCE

Improved understanding of these syndromes may elucidate the pathogenesis and etiology of bipolar disorders and the neuropsychiatric syndromes affecting mood, motivation and behavioural disinhibition.

Case study: mania associated with multiple sclerosis

Mania occurs sometimes in association with an organic condition affecting the brain. A case of a 15-year-old girl with secondary mania related to multiple sclerosis is described, along with a selective review of the subject. The English-language literature published from 1986 to 1994 was reviewed, but geriatric and mentally retarded cases were excluded. This case points out that organic causes, often multifactorial, have to be kept in mind when treating patients who have mania.