The phenomenon of conversion to bipolarity after many years of unipolar depression has led to speculation that cerebral organic factors may play a part in the aetiology of late-onset mania. In support of this, cognitive function is significantly impaired in between one-fifth and one-third of elderly manics. (4 4 ,50) Furthermore, studies (summarized by Shulman(48)) have shown a high rate of neurological disturbance, cerebral deep white-matter lesions, and reduced heritability in late-life mania.

Krauthammer and Klerman(51) introduced the term 'secondary mania' to denote manic illness that starts without a prior history of affective disorder in close temporal relationship to a physical illness or drug treatment, and often in the absence of a family history of affective illness. A large number of conditions have been associated with secondary mania, including stroke, head injury, tumours, and non-specific lesions to the right side of the brain.

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