Vascular mania: an old concept in danger of sclerosing? A clinical overview

Abstract

To review the evidence for an association between vascular disease and mania, and in this context, to assess the suitability of previously proposed diagnostic criteria. Relevant articles were retrieved and reviewed with the aid of search engines [MEDLINE, PsychInfo and EMBASE from 1996 to 2006] using pertinent search terms. Because of the paucity of data, systematic criteria for levels of evidence could not be applied. The literature is limited by the preponderance of case reports or case series, the use of overlapping terms, such as secondary mania, disinhibition syndrome and poststroke mania, and variable definitions of mania per se. There is general support for a tentative association between mania and vascular risk factors, and also between mania and cerebrovascular disease. Such associations seem best described by the term vascular mania for the sake of clinical utility, although it erroneously conveys causality. Proposed diagnostic criteria have defined a late-age at onset (50 years +) sub-type of mania, with associated neuroimaging and neuropsychological changes which are not specific to this age group. Further studies are needed to determine whether mania associated with vascular disease is a specific and separate sub-type with a late-age at onset. An alternative framework for considering vascular mania is proposed.