K I Shulman1. 1. Department of Psychiatry, Sunnybrook Health Science Centre, Toronto, ON, Canada. ken.shulman@sunnybrook.on.ca
Abstract
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.
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.
Authors: Koji Matsuo; Mark Nicoletti; Kiyotaka Nemoto; John P Hatch; Marco A M Peluso; Fabiano G Nery; Jair C Soares Journal: Hum Brain Mapp Date: 2009-04 Impact factor: 5.038