Secondary mania as a presentation of progressive dialysis encephalopathy

A case of acute mania in a 50-year-old woman who had received hemodialysis treatment for 2 1/2 years is described. The patient's presentation with secondary manic and associated psychotic features was the initial symptom of the syndrome of progressive dialysis encephalopathy (PDE). Shortly thereafter, an abnormal EEG tracing was obtained. Several months later she developed dysarthria and muscular twitchings and EEG changes persisted, a symptom complex characteristic of PDE. The appearance of psychiatric symptoms among patients receiving chronic dialysis treatment may herald the onset of PDE.