Cummings J L
Psychiatr Clin North Am. 1986 Jun;9(2):293-311.
Organic delusional disorders and secondary mania are clinical syndromes produced by neurologic diseases and toxic-metabolic disorders. Delusional disorders are associated primarily with limbic system lesions and basal ganglia dysfunction. These two groups of structures are united into a single system involved in the assessment of ongoing perception and experience, and dysfunction in these structures may explain the presence of psychosis. Lesions producing delusional disorders involve dopaminergic projections considered important in idiopathic schizophrenia, and involvement of similar anatomic and biochemical systems may explain the identity of symptoms noted in both disorders. Secondary mania is associated with deep midline lesions and with pharmacologic agents affecting monoaminergic function. Midline lesions may involve reward-system nuclei and euphoriant enkephalins to produce an elevated mood and hypothalamic nuclei to produce alterations in sleep, appetite, and libido. Mania appears to be more common with right-sided than with left-sided lesions. Lesions, metabolic disturbances, and drugs causing mania may disturb serotonergic and noradrenergic transmitters implicated in idiopathic bipolar disease. Study of the organic psychoses is providing insight into the neurophysiologic basis of idiopathic psychotic disorders. Clinically, greater awareness of the organic psychoses may lead to the discovery of additional cases of secondary mania and organic delusional disorders with potentially treatable neuromedical causes.
器质性妄想障碍和继发性躁狂是由神经疾病和中毒代谢紊乱引起的临床综合征。妄想障碍主要与边缘系统病变和基底神经节功能障碍有关。这两组结构共同构成一个单一系统，参与对当前感知和体验的评估，这些结构的功能障碍可能解释了精神病的存在。导致妄想障碍的病变涉及在特发性精神分裂症中被认为重要的多巴胺能投射，相似的解剖和生化系统的参与可能解释了两种疾病中所观察到的症状的一致性。继发性躁狂与深部中线病变以及影响单胺能功能的药物有关。中线病变可能累及奖赏系统核团和产生欣快感的脑啡肽以导致情绪高涨，还可能累及下丘脑核团以引起睡眠、食欲和性欲的改变。躁狂似乎在右侧病变时比左侧病变时更常见。导致躁狂的病变、代谢紊乱和药物可能干扰特发性双相情感障碍中涉及的血清素能和去甲肾上腺素能递质。对器质性精神病的研究正在为深入了解特发性精神病性障碍的神经生理基础提供线索。临床上，对器质性精神病有更高的认识可能会促使发现更多具有潜在可治疗的神经医学病因的继发性躁狂和器质性妄想障碍病例。
