title: Late onset mania as an organic syndrome: A review of case reports in the literature.
abstract: OBJECTIVE
  Although First Episode Mania presenting over the age of 50 is reported in several cases, there has been little systematic compilation of these case reports. We report a review of case reports on these subjects.
  
  
  METHODS
  We undertook a literature search on MEDLINE, PsychInfo and EMBASE to identify case reports of first episode of mania or hypomania presenting over the age of 50.
  
  
  RESULTS
  35 cases were identified. 29/35 (82%) had a suspected underlying organic cause. Organic causes included vascular causes, iatrogenic drug use, electrolyte imbalance, dementia and thyroid disease. Vascular risk factors were present in 17/35 cases (48%). In 10/35 (28%) of cases organic treatment contributed to successful remission of the manic episode.
  
  
  CONCLUSIONS
  As evidently not all cases have been reported the main limitation is that of publication bias for this paper. Any such hypothesis generated from studying these cases would require replication in prospective longitudinal trials of this cohort of patients.
  
  
  CONCLUSIONS
  This review of case reports appears to add to evidence of late onset mania having an organic basis. Whether this is a separate organic syndrome remains to be established. Our provisional findings suggest that such patients should have a thorough medical and psychiatric screening in identifying an underlying cause.
authors.affiliation: Kent & Medway Partnership Trust, UK; Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.
authors.forename: Musa
authors.initials: M
authors.lastname: Sami
authors.affiliation: East Kent University Hospitals NHS Trust, UK.
authors.forename: Hina
authors.initials: H
authors.lastname: Khan
authors.affiliation: Surrey & Borders NHS Partnership Trust, Brain Science Research Unit, ACU, Holloway Hill, Lyne, Chertsey Surrey KT16 0AE, UK. Electronic address: ramin.nilforooshan@sabp.nhs.uk.
authors.forename: Ramin
authors.initials: R
authors.lastname: Nilforooshan
mesh_terms: D001714:Bipolar Disorder / Q000209:etiology*; D003704:Dementia / Q000150:complications; D006801:Humans; D000067562:Late Onset Disorders / Q000209:etiology*; D019966:Substance-Related Disorders / Q000150:complications; D013577:Syndrome; D013959:Thyroid Diseases / Q000150:complications; D014652:Vascular Diseases / Q000150:complications; D014882:Water-Electrolyte Balance
keywords: First-episode; Geriatric; Hypomania; Late-life; Mania