Bipolar Disorder in Neurologic Illness

Patients with neurologic illness frequently develop secondary mood disorders that are broadly categorized as unipolar or bipolar illnesses. Although depressive disorders are more commonly seen in neurologic patients, bipolar illnesses can be as debilitating and more difficult to treat. Distinguishing between primary manias (ie, no known brain injury) and secondary manias (ie, etiologically linked to a disease) is important, because secondary manias may present with different symptoms and require different treatments from primary manias. Aggressive treatment of mania improves quality of life, reduces morbidity and mortality, and may prevent worsening of both psychiatric and neurologic disease. Bipolar disorder associated with neurologic illness typically requires treatment with mood stabilizers such as lithium, divalproex sodium, or carbamazepine. A number of other pharmacologic treatments are emerging, many of them using antiepileptic drugs that may have dual use in neurologic patients. Although psychotherapy in combination with medication improves outcome in bipolar illness, psychotherapy alone is not effective for this condition. Treatment of bipolar disorder, especially in the depressed phase, is complicated, and should be referred to a psychiatrist.