P-744 - “Organic” mania in latter life

Abstract

Introduction Bipolar disorder is commonly associated with early adulthood, although a substantial proportion of patients develops the condition in later life. The results of early investigations suggested that cases of bipolar disorder with onset in later life were more often associated with organic causeś, and could potentially justify the distinction between early and late onset bipolar disorder. Objectives and Aims Alert for organic causes of mania. Methods Review of relevant literature after the description of a clinical case. Results Description of clinical case: J.C. is a man of 80 years without psychiatric history that is admitted in a Oncology Service for dehydration. He has breast cancer since 2005, treated with neoadjuvant-chemotherapy, mastectomy and hormone-therapy with remission. In 2010 there was progression of the disease and he restart chemotherapy. He started odd behaviors and refusal to take medication and it was made the request for observation of liaison psychiatry. In the psychopathological observation is notorious a psychomotor agitation with sexual deshinibition, grandiosity ideas and dysphoric mood. It was placed the diagnostic hypothesis of mood disturbance due to cancer progression with manic characteristics that was supported by evidence in neuroimaging of metastization in frontal-parietal-occipital cranial bones. He started medication with halopheridol with remission of the psychiatric symptoms. Conclusions It is described a case of an old-age patient, without psychiatric background, with progression of his cancer disease, that suddenly starts manic symptoms. The manic states due to organic causes are more rare then other affective disorders and the clinician has to be alert.