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Case Reports in Psychiatry
Volume 2016, Article ID 1393982, 5 pages
Case Report

Late-Onset Mania in a Patient with Movement Disorder and Basal Ganglia Calcifications: A Challenge for Diagnosis and Treatment

1Department of Neurosciences, Section of Psychiatry, University of Padova, 35128 Padova, Italy
2Department of Psychiatry, University of Pisa, 56121 Pisa, Italy
3The Institute of Behavioral Sciences “G. De Lisio”, 56127 Pisa, Italy

Received 8 February 2016; Revised 29 March 2016; Accepted 6 April 2016

Academic Editor: Erik Jönsson

Copyright © 2016 Beatrice Roiter et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Age of onset can have a significant impact on clinical course and pathophysiological mechanism of bipolar disorder. Late-onset bipolar episodes are more likely linked to medical illnesses and so are frequently classified as “secondary” forms of mood disorder. We discuss the case of a patient who at the age of 58 presented his first delusional-manic episode. He also had mild frontal and occipital cortical atrophy, white matter posterior ischemic lesions, and small basal ganglia calcifications. Seven years later, he presented a second manic episode with new emergent hyperkinetic choreiform symptoms. Taking into account movement disturbances, the presence of basal ganglia calcification, and worsening of cortical atrophy, we performed a differential diagnosis between Fahr disease, Fahr’s syndrome, calcifications due to ageing, supersensitivity psychosis, and dementia. Valproate, quetiapine, and tetrabenazine were sequentially administered and yielded a good therapeutic response as regards manic and movement symptoms. Relationship between medications and course of specific symptoms was observed.