The Expression of Bipolar Affective Disorders in Brain Injured Patients

Abstract

Objective:

A prospective study was designed to investigate the varied presentations of major affective disorders in patients with organic brain disease.

Method:

Patients admitted to our neuropsychiatry service, with affective and behavioral disturbances, and known neurological disorders, were classified, on phenomenological grounds, into the following groups: 1) elated mania; 2) irritable mania; 3) affective lability with periods of irritability, but without other symptoms pathognomonic for mania; and 4) intermittent psychosis with absent or ambiguous mood changes.

Results:

A majority of patients in all four groups responded to pharmacotherapy with anti-cycling agents.

Conclusions:

It is proposed that these groups represent different expressions of mania in brain injured persons, and that these expressions range through a spectrum of phenomenology, included elated mania, irritable mania, episodic psychosis and explosive organic personality disorder. The DSM-III-R classification of these disorders, and approaches to their clinical management, are discussed.

Keywords

affective disorders affective symptoms bipolar disorder manic disorder organic mental disorders brain injuries head injuries delusions aggression organic mood disorders cycloid psychoses episodic dyscontrol

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