Organic Causes of Mania

ERIC W. LARSON, M.D., Department of Psychiatry and Psychology; ELLIOTT RICHELSON, M.D., Department of Psychiatry and Psychology and Department of Pharmacology
Manic syndromes have many neurologic, toxic, and metabolic causes. It is important
for clinicians to be able to distinguish these organic disorders from primary idiopathic
mania (bipolar disorder). The cardinal symptom of organic mania is an abnormally and
persistently elevated or irritable mood. Organic mania usually develops in patients who
are older than 35 years of age, whereas bipolar disorder generally has its onset between
late adolescence and age 25 years. In patients with the first episode of mania, the
clinician should thoroughly elicit information about current symptoms, recent infec­ tions, use of drugs, and past or family history of psychiatric disorders. In addition, a complete medical examination, computed tomography of the head, electroencephalog- raphy, and screening for drugs and toxins should be done. Treatment of organic mania
includes correcting the underlying disorder when possible.


Manic syndromes, a type of affective illness, are relatively common; the lifetime risk for either sex is about 1%.1 In addition, many toxic, metabolic, and neurologic disorders have been associated with mania. The practitioner should be able to distinguish these disorders from idiopathic manic-depressive illness or bipolar disorder. In this article, we review the clinical features and differential diagnosis of mania, with emphasis
on current information about pathologic anatomic changes and neurochemistry. We also discuss evaluation and treatment strategies. Following standard nomenclature, we use the term “organic” to describe mania secondary to an identifiable medical condition. “Bipolar disorder” is used to describe the primary psychiatric syndrome for which an organic lesion is likely but has not yet been identified. For the purposes of this article, idiopathic bipolar disorder will be distinguished from “organic” mania.

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Mayo Clin Proc 63:906-912,1988

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