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Am J Psychiatry 1993; 150:916-921
Copyright © 1993 by American Psychiatric Association
Secondary mania following traumatic brain injury
RE Jorge, RG Robinson, SE Starkstein, SV Arndt, AW Forrester and FH Geisler
Department of Psychiatry, College of Medicine, University of Iowa.
OBJECTIVE: In this study patients were examined during the first year after
traumatic brain injury to determine the presence of secondary mania.
METHOD: A consecutive series of 66 patients with closed-head injury were
evaluated in the hospital and at 3-, 6-, and 12-month follow-ups. The
patients were examined with a semistructured psychiatric interview and
scales for measurement of impairment in activities of daily living,
intellectual function, and social functioning. Patients fulfilling the
DSM-III-R criteria for mania were compared to patients with major
depression and to patients without affective disturbances in regard to
their background characteristics, impairment variables, and lesion
locations. RESULTS: Six patients (9%) met the criteria for mania at some
point during follow-up. The presence of temporal basal polar lesions was
significantly associated with secondary mania even when the effect of other
lesion locations was taken into account. Secondary mania was not found to
be associated with the severity of brain injury, degree of physical or
cognitive impairment, level of social functioning, or previous family or
personal history of psychiatric disorder. The duration of mania, however,
appeared to be brief, lasting approximately 2 months. CONCLUSIONS: The 9%
frequency of secondary mania in these patients with traumatic brain injury
is significantly greater than that seen in other brain-injured populations
(e.g., patients with stroke). The major correlate was the presence of a
temporal basal polar lesion.
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