El Hayek Samer, El-Khoury Joseph
Department of Psychiatry, American University of Beirut, Beirut, Lebanon.
Department of Psychiatry, American University of Beirut, Beirut, Lebanon
BMJ Case Rep. 2020 Feb 26;13(2):e233403. doi: 10.1136/bcr-2019-233403.
Episodes of mania typically occur in the context of bipolar disorder, with an average age of onset of 25 years. A condition with identical symptoms, known as secondary mania, generally occurs in isolation in older adults and has an identifiable organic etiology. Here, we report a 57-year-old man who presented to the emergency department with a 3 weeks history of sudden onset mania with psychotic symptoms. He had no previous psychiatric history, and his presentation coincided with the initiation of a course of steroids. Despite the absence of physical symptoms, investigations revealed a previously undetected adrenocorticotropic hormone-releasing small cell lung carcinoma that led to his death within months. This case highlights the complexity of distinguishing primary from secondary mania when it occurs after the peak incidence period of early adulthood. Undertaking a comprehensive medical workup is generally recommended.
躁狂发作通常发生在双相情感障碍的背景下，平均发病年龄为25岁。一种具有相同症状的病症，称为继发性躁狂，通常单独发生在老年人中，并有可识别的器质性病因。在此，我们报告一名57岁男性，他因突发躁狂伴精神病症状3周病史就诊于急诊科。他既往无精神病史，其症状出现与开始使用类固醇疗程的时间相符。尽管没有躯体症状，但检查发现了此前未被检测到的促肾上腺皮质激素释放型小细胞肺癌，该患者在数月内死亡。该病例突出了在成年早期发病高峰期之后出现躁狂时，区分原发性躁狂和继发性躁狂的复杂性。一般建议进行全面的医学检查。
