The expression of bipolar affective disorders in brain injured patients.

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.