van Lammeren A, Dols A, van Gerven H, Kupka R W, Stek M L
VUmc, polikliniek ouderenpsychiatrie te Amsterdam.
Tijdschr Psychiatr. 2011;53(11):813-23.
The underlying cause of mania in later life can be an early- or late-onset bipolar disorder or it can be a mood disorder arising from a physical illness, also known as 'a secondary mania'. Thorough diagnostic tests are needed to differentiate between the two types of mania.
To discuss the epidemiology, presentation, diagnostic considerations and treatment options when a mania develops in later life.
The literature was studied systematically with the help of PubMed, the Cochrane Library, specialist manuals, Dutch guidelines and references.
So far, research into the incidence and prevalence of a mania in later life has been very limited. In making a differential diagnosis of this kind of mania the clinician has to consider not only the possibility of a bipolar disorder, severe depression or psychosis but also the possibility of delirium, dementia or secondary mania. According to some researchers, a mania can be caused by various neurological, systemic and pharmacological factors. Patients should be given somatic screening, including brain imaging. Lithium and antipsychotics are the agents of choice for treating a mania occurring as part of a bipolar disorder as well as for treating a secondary mania.
Epidemiologic research into late-onset mania is limited. In older patients it is important to identify -or rule out- somatic causes (secondary mania, dementia, delirium). Symptomatic treatment is more or less on the same lines as the treatment for mania in young adults. In cases of secondary mania maintenance treatment is not always necessary, but must be considered if risk factors for bipolar disorder are present.
晚年躁狂的潜在病因可能是早发性或晚发性双相情感障碍，也可能是由躯体疾病引起的情绪障碍，即“继发性躁狂”。需要进行全面的诊断测试来区分这两种类型的躁狂。
探讨晚年发生躁狂时的流行病学、临床表现、诊断要点及治疗选择。
借助PubMed、Cochrane图书馆、专业手册、荷兰指南及参考文献对文献进行系统研究。
迄今为止，关于晚年躁狂发病率和患病率的研究非常有限。在对这类躁狂进行鉴别诊断时，临床医生不仅要考虑双相情感障碍、重度抑郁或精神病的可能性，还要考虑谵妄、痴呆或继发性躁狂的可能性。一些研究人员认为，躁狂可能由多种神经、全身及药物因素引起。应对患者进行躯体检查，包括脑成像检查。锂盐和抗精神病药物是治疗双相情感障碍所致躁狂以及继发性躁狂的首选药物。
晚发性躁狂的流行病学研究有限。对老年患者而言，识别或排除躯体病因（继发性躁狂、痴呆、谵妄）很重要。对症治疗与年轻成人躁狂的治疗大致相同。对于继发性躁狂患者，维持治疗并非总是必要，但如果存在双相情感障碍的危险因素，则必须考虑进行维持治疗。
