DISINHIBITION SYNDROMES, SECONDARY MANIA AND BIPOLAR DISORDER IN OLD-AGE

Background: The neurological literature concerning disinhibition syndr omes and secondary mania has run in parallel to clinical reports of bi polar disorder in old age. Methods: A critical review was conducted of both the neurological and geriatric psychiatry literature in an attem pt to integrate the two streams. Results: Disinhibition syndromes incl ude lateralization to the right hemisphere and localization of lesions to the orbite-frontal and basotemporal cortex involving limbic and fr ontal connections (orbite-frontal circuit). Mania in old age is associ ated with late onset, heterogeneous neurological disorders and poor ou tcome. Conclusion: Bipolar disorders in old age may be understood in t he context of affective vulnerability influenced by a specific neurobi ologic substrate. Limitations: The clinical literature consists predom inantly of small case series and anecdotal reports. Clinical relevance : Improved understanding of these syndromes may elucidate the pathogen esis and etiology of bipolar disorders and the neuropsychiatric syndro mes affecting mood, motivation and behavioural disinhibition. (C) 1997 Elsevier Science B.V.