Frontal meningioma and bipolar disorder: Etiopathogenic link or co-morbidity? A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S678-S678
Author(s):  
I. Chaari ◽  
H. Ben Ammar ◽  
R. Nefzi ◽  
N. Mhedhbi ◽  
E. Khelifa ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Suicide Attempts ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Manic Episode ◽  
Atypical Symptoms ◽  
Co Morbidity ◽  
Major Depressive Episodes ◽  
Depressive Episodes

IntroductionFrontal meningiomas are benign brain tumours known for their late onset. They may be presented by only psychiatric symptoms. Thus, the diagnosis at early stages can be missed or overlooked until the tumour causes neurological deficit.Case reportWe report the case of a 61-year-old man, receiving a treatment and a follow-up for bipolar disorder for 11 years. He has history of 3 major depressive episodes, 2 suicide attempts and a manic episode. The symptoms were initially well controlled by medication. Since 6 months, the patient started to experience atypical symptoms: he had presented disinhibited and aggressive behaviour, psychomotor instability, pyromania and self-neglect. The patient did not respond to treatment despite repeated adjustments. A frontal syndrome was suspected. Cerebral CT scan revealed an unexpected mass measuring 6.8 cm × 5.6 cm at the right frontal area, suggestive of a giant meningioma (Fig 1).ConclusionsGenerally, once diagnosed, psychiatric disorders are rarely revised. Consequently, “silent” tumours such as frontal meningiomas can be overlooked. Neuroimaging should be considered in case of new-onset psychiatric symptoms, atypical or change in clinical presentation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

First manic episode in a patient with a frontal meningioma

2016 ◽  
Vol 33 (S1) ◽  
pp. S339-S340
Author(s):  
M. Queirós ◽  
J. Caseiro
Keyword(s):  
Psychiatric Symptoms ◽  
Medical Condition ◽  
Benign Lesion ◽  
Brain Mri ◽  
Manic Episode ◽  
Major Depressive ◽  
Pubmed Database ◽  
Psychotic Features ◽  
Major Depressive Episodes ◽  
Depressive Episodes

IntroductionPsychiatric symptoms are common among brain tumor patients. Meningiomas are the most common benign brain tumors accounting for 13 to 26% of all intracranial tumors and might present exclusively with psychiatric symptoms. To diagnose a manic episode according to DSM-5 criteria the episode must not be attributable to the physiological effects of a substance or to another medical condition.Objectives/aimsDescribe a case of first manic episode with a frontal meningioma along with a brief review of available literature.MethodsThe case we report is based on information collected from interviews with the patient and the family members as well as from the clinical files. The literature review was performed using the PubMed database.ResultsWe describe the case of a 58-year-old woman presenting with symptoms of a first manic episode with psychotic features. There were no previous hypomanic or major depressive episodes. In order to exclude organic causes a brain CT scan was performed that revealed a possible frontal lesion. A brain MRI confirmed the presence of a frontal meningioma with an approximate diameter of 1.4 cm.ConclusionsThe majority of the cases described in the literature refer to large tumors presenting with major depressive symptoms. Given the absence of similar cases in the literature, it seems unlikely that such a small benign lesion may cause a manic episode with psychotic features. Nevertheless, we cannot exclude that possibility.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Late-Onset Manic Episode after Bariatric Surgery

2019 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Bariatric Surgery ◽  
Bipolar Disorder ◽  
Late Onset ◽  
Manic Episode ◽  
Personal History ◽  
Somatic Comorbidity ◽  
Depressive Episodes ◽  
Irritable Mood

A manic episode is a clearly recognizable period with an abnormally and persistently elevated, expansive or irritable mood, with an abnormal and persistently increased targeted activity of energy, present for a week and during the biggest part of the day [1]. The episode usually fits within a bipolar disorder, in which also depressive episodes occur. These episodes often precede the manic phase. When a first manic episode occurs at a later age without any personal history, a somatic cause must always be excluded. Lateonset mania is associated with increased somatic comorbidity in patients aged 50 years and older. [2]

scholarly journals 508 - LATE ONSET BIPOLAR DISORDER: CASE REPORT AND LITERATURE REVIEW

2021 ◽  
Vol 33 (S1) ◽  
pp. 60-60
Author(s):  
Joana Regala ◽  
João Reis
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Electroconvulsive Therapy ◽  
Late Onset ◽  
Diffuse Axonal Injury ◽  
First Episode ◽  
Triggering Factors ◽  
History Of ◽  
Secondary Mania ◽  
Depressive Episodes

Background:Late-onset bipolar disorder (LOBD) remains an incompletely understood nosological entity, in reason of its complexity and the paucity of research in this issue. It is not yet clear whether LOBD is a “phenocopy” of the classic early-onset bipolar disorder (EOBD), sharing symptoms but having a different aetiology, or whether both have a common underlying vulnerability that interacts with age-specific triggering factors. Some authors have proposed that LOBD is a heterogeneous entity, comprising secondary mania (including organic brain disease), bipolarity in the context of dementia-like processes (BD type VI), and LOBD as expression of a lower vulnerability to bipolarity.Case Report:Female patient with previous medical history of hypertension and dyslipidaemia, and psychiatric history of recurrent severe depressive episodes since early age, with melancholic and psychotic features, had a first hypomanic episode at 76 years-old, under treatment with tricyclic antidepressant and electroconvulsive therapy. Meanwhile, she suffered a traumatic brain injury (TBI) complicated with subdural and subarachnoid hematoma, as well as intraventricular haemorrhage, which is an indirect sign of diffuse axonal injury (DAI). Later, at 79 years-old, she presented a mixed episode characterized by racing thoughts, flight of ideas, non-systematized persecutory and ruin delusions, hyposomnia, and ultradian alternation between dysphoric and depressive mood, psychomotor agitation and retardation, emotional lability, hypersyntonic contact and hostility. Medical conditions that could account for secondary mania were ruled out. This clinical picture subsided within few weeks under treatment with olanzapine and electroconvulsive therapy. After recovery memory deficits were noticed.Concluding remarks:This case illustrates a “latent” BD, in a patient with previous recurrent depressive disorder, manifesting the first episode of mania in late life. Several triggering factors may have contributed to this longitudinal evolution, lowering the threshold to manifest mania, namely cerebrovascular risk factors, a possible underlying degenerative process and DAI secondary to TBI, which through structural dysconnectivity also contributes to cognitive dysfunction. The deleterious effect of recurrent and severe depressive episodes on cognition is well documented. The question of whether some forms of LOBD could constitute a special risk factor for developing dementia deserves further investigation.

scholarly journals Varying temporal criteria for generalized anxiety disorder: prevalence and clinical characteristics in a young age cohort

2006 ◽  
Vol 36 (9) ◽  
pp. 1283-1292 ◽  
Author(s):  
JULES ANGST ◽  
ALEX GAMMA ◽  
O. JOSEPH BIENVENU ◽  
WILLIAM W. EATON ◽  
VLADETA AJDACIC ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Suicide Attempts ◽  
Social Impairment ◽  
Generalized Anxiety ◽  
Co Morbidity ◽  
Dsm Iv ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Duration Criterion

Background. This study questions the 6-month duration criterion for generalized anxiety disorder (GAD) used in DSM-III-R and DSM-IV.Method. In adults from age 20/21 to 40/41 in the prospective Zurich Cohort Study, four groups of generalized anxiety syndromes defined by varying duration (2 weeks, 1 month, 3 months and 6 months) were compared.Results. Applying DSM-III (1979–1999) and DSM-III-R (1986–1999) criteria, there were no significant differences between the four groups in terms of family history of anxiety, work impairment, distress, treatment rates or co-morbidity with major depressive episodes (MDEs), bipolar disorder or suicide attempts. Only social impairment related to the length of episodes. The 6-month criterion of DSM-III-R and DSM-IV GAD would preclude this diagnosis in about half of the subjects treated for generalized anxiety syndromes.Conclusions. In this epidemiological sample, the 6-month duration criterion for GAD could not be confirmed as clinically meaningful. GAD syndromes of varying duration form a continuum with comparable clinical relevance.

Treatment of Bipolar Disorder During the Postpartum Period

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S5) ◽  
pp. 13-14
Author(s):  
Adele C. Viguera
Keyword(s):  
Bipolar Disorder ◽  
Postpartum Period ◽  
Clinical Information ◽  
Mood Stabilizer ◽  
Mood Stabilizers ◽  
Antipsychotic Treatment ◽  
Close Monitoring ◽  
Major Congenital Malformations ◽  
Major Depressive Episodes ◽  
Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients

2011 ◽  
Vol 27 (8) ◽  
pp. 557-562 ◽  
Author(s):  
J.-M. Azorin ◽  
A. Kaladjian ◽  
M. Adida ◽  
E. Fakra ◽  
E. Hantouche ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempts ◽  
Correct Diagnosis ◽  
Manic Episode ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Prodromal Phase ◽  
Multiple Episode ◽  
Patients At Risk ◽  
Bipolar Patients

AbstractObjective:To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition.Methods:One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics.Results:Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year.Conclusion:In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.

scholarly journals Neurocysticercosis presenting as bipolar disorder: a case report

2021 ◽  
Vol 34 (6) ◽  
pp. e100663
Author(s):  
Surbhi Batra ◽  
Sumit Kumar ◽  
Lokesh Singh Shekhawat
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Depressive Symptoms ◽  
Affective Disorder ◽  
Postpartum Period ◽  
Bipolar Affective Disorder ◽  
Taenia Solium ◽  
Manic Episode ◽  
Symptoms And Signs ◽  
Rule Out

Neurocysticercosis is the most common neuro-parasitosis caused by the larval stage of Taenia solium. The most common manifestations include seizures and hydrocephalus. Psychiatric abnormalities are relatively rare but depressive symptoms are frequent in patients with neurocysticercosis. However, mania as a presentation is relatively rare. Pregnancy and the postpartum period are relatively vulnerable times and they can lead to reactivation of existing neurocysterci lesions. We are discussing the case of a 23-year-old female patient with neurocysticercosis leading to the reactivation of lesions in the peripartum and postpartum period leading to bipolar affective disorder. Improvement in the patient was seen with a combination of antipsychotics, antihelmintics, antiepileptics and steroids, along with improved radiological signs of neurocysterci lesions. Although neurocysticercosis is a common illness, its prevalence presenting as a manic episode is merely 2.6% and, hence, missed easily. Therefore, it is important to rule out organic aetiology in patients even with a classic presentation of bipolar affective disorder and those having any other neurological symptoms and signs.

Risk factors for suicide attempts in patients with bipolar disorder misdiagnosed with major depressive disorder: results from a national survey in China

2020 ◽  
Author(s):  
Lin Chen ◽  
Yu-Yu Xu ◽  
Jing-Ge Du ◽  
Li-Min Xin ◽  
Su-Li Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bipolar Disorder ◽  
Suicidal Ideation ◽  
Clinical Characteristics ◽  
Suicide Attempts ◽  
Multiple Logistic Regression ◽  
Regression Analyses ◽  
Major Depressive ◽  
Suicide Attempters ◽  
Depressive Episodes

Abstract Background: Bipolar disorder (BD) is a kind of mental disorder with the greatest risk of suicide, but it is often misdiagnosed as major depressive disorder (MDD) clinically. This study aimed to analyze the sociodemographic factors and clinical characteristics associated with suicide attempts (SA) in patients with BD misdiagnosed with MDD in China. Methods: A total of 1487 MDD patients were consecutively enrolled in 13 mental health centers in China. Data on patients’ sociodemographic and clinical characteristics were collected using a standardized protocol. Of these, 306 BD patients were misdiagnosed with MDD according to the Mini International Neuropsychiatric Interview (MINI). Suicide attempters and non-attempters were classified by the suicidality module of the MINI. Multiple logistic regression analyses were performed to assess the association between the independent variables of interest and SA in BD patients misdiagnosed with MDD. Results: Of the 306 BD patients misdiagnosed with MDD, 225 (73.5%) were non-attempters and 81 (26.5%) were attempters. Compared to non-attempters, attempters were older (Z =2.2, p = 0.03) and had more admissions(χ2 =6.1, p = 0.013), more frequent depressive episodes, more atypical characteristics (e.g. increased appetite, weight gain, and more sleep time)(χ2 = 5.8, p = 0.016), more suicidal ideation (χ2 = 27.3, p < 0.001), more psychotic symptoms (χ2 = 7.4, p = 0.006) and more seasonal depressive episodes (χ2 = 5.6, p = 0.018). Multiple logistic regression analyses revealed that attempters were characterized by more suicidal ideation (OR = 5.7, 95% CI: 2.6–12.5) and frequent depressive episodes (OR = 2.4, 95% CI: 1.3–4.6). The limitations of this study include its cross-sectional design and data collection by suicide attempters’ retrospective recall. Conclusions: The findings of this study suggest that BD patients misdiagnosed with MDD are at a higher risk of suicide, and more frequent depressive episodes and suicidal ideation are risk factors for attempted suicide. Early identification of and interventions for these risk factors might reduce the risk of suicide in BD patients misdiagnosed with MDD.

Hassle Faced with Induced Mania in Elderly Female While Treating for OC Symptoms. A Case Report.

2020 ◽  
Author(s):  
POONAM BHARTI ◽  
Angad harshbir singh ◽  
Parul Gupta
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Index Case ◽  
Opportunity To Learn ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Elderly Female ◽  
Co Morbidity ◽  
The Common ◽  
Treatment Aspect

Abstract Background- Obsessive-compulsive disorder (OCD) is one of the most frequently associated comorbidities in bipolar disorder (BD). While this presents a challenge in understanding the phenomenology and also the treatment aspect of co occurrence of mania with OCD. Case history- The index case is of an elderly female who presented with OC symptoms and while on treatment had mania episodes. The mania episodes presented challenges while managing underlying OC symptoms. Conclusion- The common neurobiological mechanism for the co-morbid illness and treatment lacunae are discussed. The serotonin, dopamine, and glutamate having important role in BD-OCD were evaluated to understand the neurobiological basis of BD-OCD. The index case presented with the challenge of understanding the phenomenology of the illness but also presented with opportunity to learn and successfully manage patients with such co-morbidity. Divalproex and risperidone combo was found to be effective in controlling mania in OCD patients.

scholarly journals Demoralization and Its Relationship with Depression and Hopelessness in Suicidal Patients Attending an Emergency Department

2020 ◽  
Vol 17 (7) ◽  
pp. 2232 ◽  
Author(s):  
Alessandra Costanza ◽  
Marc Baertschi ◽  
Hélène Richard-Lepouriel ◽  
Kerstin Weber ◽  
Isabella Berardelli ◽  
...  
Keyword(s):  
Suicide Attempts ◽  
Cross Sectional Study ◽  
Suicidal Patient ◽  
Cross Sectional ◽  
Psychotherapeutic Interventions ◽  
Suicidal Patients ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
The Relationship

Emergency departments (EDs) play an increasingly crucial role in the management of patients with suicidal behavior (SB). Demoralization has been associated with SB in various populations and conditions, but little is known about the effect of this construct in SB patients who attend an ED. Therefore, a more inclusive SB assessment which considers the demoralization construct could be useful in clinical practice. The main aim of this study was to assess the presence and severity of demoralization in patients visiting EDs for SB. Secondly, the maintenance of the relationship between demoralization and SB after controlling for depression and the proportion of variance which accounted for hopelessness was investigated. A cross-sectional study of patients (N = 199) visiting an ED for SB was performed, which examined the role of demoralization, hopelessness, and depression on suicidal ideation (SI) and suicide attempts (SAs). Demoralization was strongly and positively correlated with SI. Demoralization was related to major depressive episodes, but it was confirmed to be a different and, probably, more sensitive construct for SB, validating its specificity in relation to depression. Hopelessness accounted for a small portion of the variance in SI, compared to demoralization. Formal support for the association of demoralization with SI was provided. Demoralization can improve SB assessment in EDs, particularly among patients whose suicide risk can be unnoticed. Furthermore, demoralization represents a clinically useful concept to increase comprehension of the suffering of the suicidal patient and a possible target for psychotherapeutic interventions.

Sign in / Sign up

Export Citation Format

Share Document