Late onset mania as an organic syndrome: A review of case reports in the literature

- This review of case reports shows that first-episode manic episode presenting over the age of 50 appears to be strongly associated with underlying organic illness.
- A variety of postulated risk factors include iatrogenic and vascular risk factors.
- Further research in large, prospective follow-up studies is required to determine more fully the strength of these associations.

AimsAlthough First Episode Mania presenting over the age of 50 is reported in several cases, there has been little systematic compilation of these case reports. We report a review of case reports on these subjects.MethodsWe undertook a literature search on MEDLINE, PsychInfo and EMBASE to identify case reports of first episode of mania or hypomania presenting over the age of 50.Results35 cases were identified. 29/35 (82%) had a suspected underlying organic cause. Organic causes included vascular causes, iatrogenic drug use, electrolyte imbalance, dementia and thyroid disease. Vascular risk factors were present in 17/35 cases (48%). In 10/35 (28%) of cases organic treatment contributed to successful remission of the manic episode.LimitationsAs evidently not all cases have been reported the main limitation is that of publication bias for this paper. Any such hypothesis generated from studying these cases would require replication in prospective longitudinal trials of this cohort of patients.ConclusionsThis review of case reports appears to add to evidence of late onset mania having an organic basis. Whether this is a separate organic syndrome remains to be established. Our provisional findings suggest that such patients should have a thorough medical and psychiatric screening in identifying an underlying cause.