SECONDARY MANIA - DIAGNOSIS AND TREATMENT

Increasing evidence indicates that subtypes of bipolar disorder differ not only in symptomatology and associated clinical features, but by d ifferences in age at onset, illness course, and response to treatment. Secondary manic states differ from typical bipolar states and are oft en especially difficult to treat. Although the correction of the under lying organic factors (toxic, metabolic, or infectious) may effectivel y reverse the manic presentation, many organic factors are not reversi ble (trauma, stroke, and aging), and the presence of these etiologic f actors can complicate traditional antimanic treatments. Lithium may be effective for treating patients with secondary mania, but data from p ublished studies show that in this population the associated adverse e ffects often limit its usefulness. Anticonvulsants appear to offer an effective alternative. Divalproex sodium, in particular, has been show n to be an effective and well-tolerated treatment in open trials in th e elderly and other patient groups with secondary mania. Controlled cl inical trials are necessary to confirm the efficacy and tolerability o f mood-stabilizing anticonvulsants in the treatment of secondary mania .