CARBON MONOXIDE INTOXICATION INDUCED MANIA

Secondary mania in a patient with delayed anoxic encephalopathy after carbon monoxide intoxication

Department of Neurology, Kwandong University College of Medicine, Myongji Hospital, Gyeonggi, Korea

Received 6 July 2005;
accepted 19 October 2005.
Available online 28 August 2006.

Abstract
Mania is a rare clinical manifestation of delayed anoxic encephalopathy (DAE). Prior case reports on mania after hypoxic injury involved patients with a previous history of mania or depression, potentially reflecting a recurrence of premorbid mood disorders after hypoxia rather than pure secondary mania. Herein, we report a 55-year-old woman with no past history of neurological or psychiatric illness, who developed mania as a symptom of DAE after carbon monoxide intoxication. Brain magnetic resonance imaging showed diffuse white matter lesions, particularly visible in the frontal white matter. This frontal lesion may have prevented frontal inhibition from being transmitted to the basotemporal limbic area, resulting in mania manifested as a burst of limbic activity.

ACUTE MANIA AND NEUROLOGICAL DISORDERS

Mario F. Mendez1

Neurobehavior Unit (116AF), Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, 90073 Los Angeles, CA, USA

Abstract

Neurologic disorders can produce “secondary” mania. Clinicians must distinguish secondary mania from primary, idiopathic manic-depressive illness (MBI). In addition to medical and drug-induced causes of secondary mania, neurologic causes usually develop in older patients who may lack a strong family history of MDI. Neurologic causes of mania include focal strokes in the right basotemporal or inferofrontal region, strokes or tumors in the perihypothalamic region, Huntington’s disease and other movement disorders, multiple sclerosis and other white matter diseases, head trauma, infections such as neurosyphilis and Creutzfeldt-Jakob disease, and frontotemporal dementia. Patients with new-onset mania require an evaluation that includes a thorough history, a neurologic examination, neuroimaging, and other selected tests. The management of patients with neurologic mania involving correcting the underlying disorder when possible and the judicious use of drugs such as the anticonvulsant medications.

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PSYCHIATRIC PRESENTATION OF CREUTZFELDT-JAKOB DISEASE

The British Journal of Psychiatry 151: 260-263 (1987)© 1987 The Royal College of Psychiatrists
Psychiatric presentation of Creutzfeldt-Jakob disease. A case report
MS Keshavan, WA Lishman and JT Hughes Maudsley Hospital.

A patient with Creutzfeldt-Jakob disease is described. Many alternative psychiatric diagnoses were considered, and the true situation only became apparent late in the clinical course.

MULTIPLE MYELOMA WITH MANIC FEATURES

Multiple Myeloma Presenting as Secondary Mania

Donald J. Kushon, MD, Sunil Verma, MD, Mahmoud Elfatah, MD, Scott F. Allen, MD, Kehinde Ogundipe, MD, Renata Angelini, MD, and Amy Mackenzie, MD
Primary Psychiatry. 2009;16(11):22-24

Disclosure: The authors report no affiliation with or financial interest in any organization that may pose a conflict of interest.

Off-label disclosure: This article includes discussion of the following unapproved medications for mood disorder due to multiple myeloma with manic features: risperidone, quetiapine fumarate, and valproic acid.

Please direct all correspondence to: Kehinde Ogundipe, MD, Drexel University College of Medicine, Department of Adult Psychiatry, 1427 Vine Street, 8th Floor, Philadelphia, PA, 19102; Tel: 215-762-6660; Fax: 215-762-6673; E-mail: Kehinde.Ogundipe@DrexelMed.edu.

Focus Points
• Psychosomatic manifestations of multiple myeloma have been described in the literature.• Multiple myeloma can be a cause of secondary mania and mania can be one of the first presenting symptoms.• Causes of mental status changes in patients with multiple myeloma include hypercalcemia, renal failure, infections, hyperammonemia, and hyperviscosity syndrome.• Multiple myeloma should be included in the differential diagnosis in patients presenting for the first time with recent onset of mania.• Recognition of multiple myeloma as a cause of secondary mania will facilitate proper treatment and prevent advancement of the disease.

Abstract
Medical conditions that can cause new onset of mania may be overlooked, leading to treatment delays. The authors seek to increase awareness of multiple myeloma as a possible cause of secondary mania. The authors report on new-onset mania in a 59-year-old woman who after further medical investigation was found to have stage III multiple myeloma. Palliative treatment for multiple myeloma resulted in a decrease in the patient’s manic symptoms and stabilization of the medical condition. Recognition of multiple myeloma as a cause of secondary mania will facilitate proper treatment and prevent advancement of the disease.

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ORGANIC MANIC DISORDERS

Psychosomatics 26: 394-402, 1985Copyright © 1985 Academy of Psychosomatic Medicine

Organic manic disorders CHRIS STASIEK M.A.1, and MARK ZETIN M.D.1

From the department of psychiatry and human behavior of the University of California, Irvine
Using specified criteria, Krauthammer and Klerman's review of the literature for causes for manic symptoms found cases of secondary mania owing to drugs, infection, neoplasm, epilepsy, and metabolic disturbances. We reviewed publications subsequent to their 1978 report for additional cases of secondary mania occurring in the absence of delirium and of prior affective illness. Our review reemphasizes the importance of the medical and neurologic history and examination, of a medication history, and of appropriate laboratory studies (electrolytes, thyroid function, syphilis serology) in evaluating manic patients for underlying medical conditions. Attention to the diagnosis of secondary mania is especially important in patients presenting with a first episode in later life and with a negative family history for mania.

45 YEAR OLD FEMALE WITH A FATAL DISEASE THOUGHT TO BE BIPOLAR DISORDER

Creutzfeldt-Jakob Disease Presenting as Secondary Mania Ivan Lendvai , M.D., Stephen M. Saravay , M.D., and Maurice D. Steinberg , M.D.

Received October 15, 1998; revised May 3, 1999; accepted May 20, 1999. From the Long Island Jewish Medical Center, Consultation-Liaison Psychiatry, New Hyde Park, New York. Address correspondence and reprint requests to Dr. Lendvai, Staten Island University Hospital, Department of Psychiatry, 375 Seguine Avenue, Staten Island, NY 10309.
Key Words: Creutzfeldt-Jakob Disease • Mania

Ours is a report of a patient with Creutzfeldt-Jakob disease who presented with mania and was initiallly diagnosed and treated for Bipolar I Disorder, manic type. Psychiatric disturbances constitute the prodromal manifestations in 18%–39% of those with Creutzfeldt-Jakob disease.1 Dementia occurs in all patients and progresses rapidly. Patients may complain of fatigue and appear apathetic; personal hygiene suffers early; in some cases irritability may be prominent.2,3 Depression has been found in more than 30% of patients with Creutzfeldt-Jakob disease, and 10% of patients with Creutzfeldt-Jakob disease need psychiatric hospitalization for depression.1,2 We were unable to find any report of mania as a prominent presenting symptom.

Case Report
The patient, a 45-year-old, married mother of two, was in her usual state of health, working as a secretary until about 8 weeks before admission to a short-term psychiatric inpatient facility. At that time, the patient began to have pressured, incoherent speech, with thoughtracing, and abrupt shifts of thoughts. She went on spending sprees and built up considerable credit card debt, buying unnecessary things. She had severe insomnia, sleeping only a few hours each night. She also complained of blurred vision and gait difficulty, the latter also noted by her family. After evaluation of these complaints and a normal magnetic resonance imaging (MRI) of the brain, she was given a diagnosis of Bipolar I Disorder, manic type. After 2 weeks, she was discharged on Haldol (haloperidol: 15 mg/day), Cogentin (benztropine: 0.5 mg bid), and Depakote (divalproex sodium: 750 mg bid). During the first week at home, she became less spontaneous, increasingly lethargic, and less interpersonally responsive, and her gait problems worsened. She spent much of her time staring into space, not speaking. During the second week at home, the patient became increasingly agitated. Her medications were stopped; Klonopin (clonazepam) was started without improvement, and the patient was hospitalized at another acute psychiatric hospital, again diagnosed as Bipolar I Disorder, manic type.

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CASE REPORT OF A 75 YEAR OLD FEMALE: FATAL PSYCHOSIS FROM CJD

Of Illusions, Hallucinations and Creutzfeldt-Jakob Disease (Heidenhain’s Variant)

J Neuropsychiatry Clin Neurosci 17:1, Winter 2005

SIR: Sporadic Creutzfeldt–Jakob disease (CJD), a rare progressive neurodegenerative disorder whose classic features include dementia, ataxia, and myoclonus can initially present with nonspecific psychiatric symptomatology such as fatigue, anxiety or a change in personality in about one third of cases, sometimes leading to erroneous diagnoses of depression or psychosis, as has been described in single patient reports. 1 In contrast to the above psychiatric symptoms, the presence of visual perceptual abnormalities such as illusions and hallucinations observed at the onset of a patient’s clinical course is usually more likely to be viewed as indicative of a medical, ophthalmologic or neurologic illness rather than of psychiatric etiology.2 We present a case of an elderly female with an initial presentation notable for the acute manifestation of visual illusions followed by visual hallucinations, but whose complicated medical course led to a variety of psychiatric diagnoses prior to her ultimate diagnosis of CJD.