Box 54 Relative contraindications to ECT

Raised intracranial pressure Instability of cervical spine Cerebral aneurysm

Recent history of cerebral haemorrhage Myocardial infarction within previous three months Aortic aneurysm Acute respiratory infection

In severe forms of mania, the inflated self-esteem may develop into delusions. Genetic and anatomical factors are important in the development of mania secondary to neurological disease.33 A study of mania following closed head injury reported that six of 66 patients (9%) had features of mania at some stage during a 12 month follow-up period, this figure being higher than has been reported in other brain-injured people. In this study mania was associated with temporal basal polar lesions; no links were established with severity of brain-injury or previous personal or family history of psychiatric disorder.34

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