OBJECTIVE Traumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. Mania is an uncommon, but debilitating, psychiatric occurrence following TBI. The literature on mania following TBI is largely limited to case reports and case series. In the present review, the investigators describe the clinical, diagnostic, and treatment characteristics of mania following TBI. METHODS A systematic search of MEDLINE, EMBASE, and PsycINFO was conducted for English-language studies published from 1980 to July 15, 2021. The included studies provided the required individual primary data and sufficient information on clinical presentation or treatment of manic symptoms. Studies with patients who reported a history of mania or bipolar disorder prior to TBI and studies with patients who sustained TBI before adulthood were excluded. RESULTS Forty-one studies were included, which reported information for 50 patients (the mean±SD age at mania onset was 39.1±14.3 years). Patients were more frequently male, aged <50 years, and without a personal or family history of psychiatric disorders. Although 74% of patients reported mania developing within 1 year following TBI, latencies of up to 31 years were observed. Illness trajectory varied from a single manic episode to recurrent mood episodes. Rapid cycling was reported in six patients. Mood stabilizers and antipsychotics were most frequently used to improve symptoms. CONCLUSIONS Heterogeneity of lesion locations and coexisting vulnerabilities make causality difficult to establish. Valproate or a second-generation antipsychotic, such as olanzapine or quetiapine, may be considered first-line therapy in the absence of high-level evidence for a more preferred treatment. Early escalation to combined therapy (mood stabilizer and second-generation antipsychotic) is recommended to control symptoms and prevent recurrence. Larger prospective studies and randomized controlled trials are needed to refine diagnostic criteria and provide definitive treatment recommendations.

中文翻译：

---

创伤性脑损伤后的躁狂症：系统回顾。

目的 创伤性脑损伤（TBI）是全世界死亡和发病的主要原因。躁狂症是脑外伤后一种罕见但令人衰弱的精神疾病。关于 TBI 后躁狂症的文献主要限于病例报告和病例系列。在本综述中，研究人员描述了 TBI 后躁狂症的临床、诊断和治疗特征。方法 对 MEDLINE、EMBASE 和 PsycINFO 进行了 1980 年至 2021 年 7 月 15 日发表的英语研究的系统检索。纳入的研究提供了所需的个人原始数据以及关于躁狂症状的临床表现或治疗的充分信息。排除了针对在 TBI 之前报告有躁狂症或双相情感障碍病史的患者的研究以及针对成年前患有 TBI 的患者的研究。结果 纳入 41 项研究，报告了 50 名患者的信息（躁狂发作时的平均±标准差年龄为 39.1±14.3 岁）。患者多为男性，年龄 <50 岁，并且没有精神疾病个人史或家族史。尽管 74% 的患者报告在 TBI 后 1 年内出现躁狂症，但观察到潜伏期长达 31 年。疾病轨迹从单一的躁狂发作到反复的情绪发作不等。据报道，六名患者出现快速循环。情绪稳定剂和抗精神病药最常用于改善症状。结论 病变位置的异质性和共存的脆弱性使得因果关系难以确定。在缺乏更优选治疗的高级证据的情况下，丙戊酸或第二代抗精神病药，例如奥氮平或喹硫平，可以被视为一线治疗。建议尽早升级为联合治疗（情绪稳定剂和第二代抗精神病药）以控制症状并预防复发。需要更大规模的前瞻性研究和随机对照试验来完善诊断标准并提供明确的治疗建议。