Shulman K I
Department of Psychiatry, Sunnybrook Health Science Centre, Toronto, ON, Canada.
J Affect Disord. 1997 Dec;46(3):175-82. doi: 10.1016/s0165-0327(97)00156-0.
The neurological literature concerning disinhibition syndromes and secondary mania has run in parallel to clinical reports of bipolar disorder in old age.
A critical review was conducted of both the neurological and geriatric psychiatry literature in an attempt to integrate the two streams.
Disinhibition syndromes include lateralization to the right hemisphere and localization of lesions to the orbito-frontal and basotemporal cortex involving limbic and frontal connections (orbito-frontal circuit). Mania in old age is associated with late onset, heterogeneous neurological disorders and poor outcome.
Bipolar disorders in old age may be understood in the context of affective vulnerability influenced by a specific neurobiologic substrate.
The clinical literature consists predominantly of small case series and anecdotal reports.
Improved understanding of these syndromes may elucidate the pathogenesis and etiology of bipolar disorders and the neuropsychiatric syndromes affecting mood, motivation and behavioural disinhibition.
关于去抑制综合征和继发性躁狂的神经学文献与老年双相情感障碍的临床报告并行发展。
对神经学和老年精神病学文献进行了批判性综述，试图将这两个领域的研究整合起来。
去抑制综合征包括右半球偏侧化以及病变定位于涉及边缘系统和额叶连接的眶额皮质和基底颞叶皮质（眶额回路）。老年躁狂与起病较晚、多种神经系统疾病以及预后不良有关。
老年双相情感障碍可在受特定神经生物学底物影响的情感易感性背景下得到理解。
临床文献主要由小病例系列和轶事报告组成。
对这些综合征的深入理解可能有助于阐明双相情感障碍以及影响情绪、动机和行为去抑制的神经精神综合征的发病机制和病因。
