Related Experiment Videos
Disinhibition syndromes, secondary mania and bipolar disorder in old age
1Department of Psychiatry, Sunnybrook Health Science Centre, Toronto, ON, Canada. ken.shulman@sunnybrook.on.ca
Background:
The neurological literature concerning disinhibition syndromes and secondary mania has run in parallel to clinical reports of bipolar disorder in old age.
Methods:
A critical review was conducted of both the neurological and geriatric psychiatry literature in an attempt to integrate the two streams.
Results:
Disinhibition syndromes include lateralization to the right hemisphere and localization of lesions to the orbito-frontal and basotemporal cortex involving limbic and frontal connections (orbito-frontal circuit). Mania in old age is associated with late onset, heterogeneous neurological disorders and poor outcome.
Conclusion:
Bipolar disorders in old age may be understood in the context of affective vulnerability influenced by a specific neurobiologic substrate.
Limitations:
The clinical literature consists predominantly of small case series and anecdotal reports.
Clinical Relevance:
Improved understanding of these syndromes may elucidate the pathogenesis and etiology of bipolar disorders and the neuropsychiatric syndromes affecting mood, motivation and behavioural disinhibition.