This page was translated automatically from Turkish. Read the original

This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0876

First episode of delirious mania in an older man with mild neurocognitive disorder due to Alzheimer's disease: a case report

FIRST PRESENTATION OF DELIRIOUS MANIA IN AN OLDER MALE WITH MILD NEUROCOGNITIVE DISORDER DUE TO ALZHEIMER’S DISEASE: A CASE REPORT

Late-onset delirious mania may be the first clinical sign of an underlying neurodegenerative process.

The aim is to describe a first episode of delirious mania in an older man with no psychiatric history and its underlying neurodegenerative basis. The patient was a 70-year-old man with no personal or family psychiatric history and no family history of dementia, who had been independent in all activities of daily living before illness onset; his reported comorbidities were hypertension, ischemic heart disease due to transthyretin cardiac amyloidosis, metastatic sigmoid colon carcinoma, chronic kidney disease, and gout. The clinical course progressed from hypomania beginning after travel one month earlier to disorganization and paranoid thoughts two weeks earlier, confusion and delirium on day 0, and agitation and prominent delusions on day 2. Investigations revealed Na 133 (low), Mg 0.69 (low), and PO4 0.92 (low) mmol/L, which were corrected with replacement on admission; B12, folate, thyroid function tests, HIV, VDRL, CSF, and EEG findings were unremarkable, and autoimmune, paraneoplastic, infectious, and toxicological screens were negative. Brain CT was normal; MRI showed no acute lesion, a medial temporal atrophy score of 1, a Fazekas score of 0, and possible mild precuneal atrophy; FDG PET/CT at one month showed hypometabolism in the inferior frontal lobes and precuneus. On cognitive assessment, the MoCA score increased from 23/30 in week 1 to 26/30 in week 6, and the FAB score was 13/18; neuropsychological assessment on day 44 revealed reduced processing speed and borderline verbal and visual memory, leading to a diagnosis of mild cognitive impairment. Treatment consisted of olanzapine 2.5 mg as needed from day 6, a scheduled dose of 5 mg on day 13, and 20 mg daily on day 23; sodium valproate was added on day 17 and titrated to 800 mg daily. Mania improved from day 24 onward, olanzapine was reduced to 10 mg because of postural hypotension and excessive sedation, and the patient was discharged in a euthymic state on day 45. The authors emphasize that, because mania in later life is uncommon (6.0% of inpatients aged 50 years and older), a first manic episode requires a comprehensive medical workup; delirious mania should be considered when mania is accompanied by fluctuating attention; antipsychotics should be used cautiously when catatonia is suspected because of the risk of malignant catatonia; and a negative workup does not rule out neurodegeneration.

All WCP 2026 summaries