title: Late-Onset Mania in a Patient with Movement Disorder and Basal Ganglia Calcifications: A Challenge for Diagnosis and Treatment.
abstract: Age of onset can have a significant impact on clinical course and pathophysiological mechanism of bipolar disorder. Late-onset bipolar episodes are more likely linked to medical illnesses and so are frequently classified as "secondary" forms of mood disorder. We discuss the case of a patient who at the age of 58 presented his first delusional-manic episode. He also had mild frontal and occipital cortical atrophy, white matter posterior ischemic lesions, and small basal ganglia calcifications. Seven years later, he presented a second manic episode with new emergent hyperkinetic choreiform symptoms. Taking into account movement disturbances, the presence of basal ganglia calcification, and worsening of cortical atrophy, we performed a differential diagnosis between Fahr disease, Fahr's syndrome, calcifications due to ageing, supersensitivity psychosis, and dementia. Valproate, quetiapine, and tetrabenazine were sequentially administered and yielded a good therapeutic response as regards manic and movement symptoms. Relationship between medications and course of specific symptoms was observed.
authors.affiliation: Department of Neurosciences, Section of Psychiatry, University of Padova, 35128 Padova, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Roiter
authors.affiliation: Department of Neurosciences, Section of Psychiatry, University of Padova, 35128 Padova, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Pigato
authors.affiliation: Department of Psychiatry, University of Pisa, 56121 Pisa, Italy; The Institute of Behavioral Sciences "G. De Lisio", 56127 Pisa, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi