Postoperative de novo manic depressive illness

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Hill et al. (1957) were one of the first to recognize that depression could occur after a temporal lobectomy. In a series evaluated by Taylor (1972), five patients committed suicide. In another follow-up study, Taylor and Marsh (1977) reported that the mortality rate during the first 2 years postoperatively was twice as high as that in any subsequent 2-year period. Further, in a Danish series investigated by Jensen and Larsen (1979), all suicide attempts occurred within the first postoperative month. A literature search failed to find any descriptions of postoperative hypomanic or manic states, except for our own recent report (Kanemoto et al., 1998). However, we were able to confirm the presence of a substantial number of cases with postoperative transient manic or hypomanic states, and a close relationship between postoperative mood disorder and preoperative history of postictal psychoses. Considering the intrinsic interrelatedness of postictal psychosis with dramatic affective changes (Kanemoto et al., 1996«; Logsdail and Toone, 1988; Savard et al., 1991), this preponderance of postoperative mood changes among patients with preoperative postictal psychosis was all the more instructive. As Trimble (1991) has warned, in view of the high incidence of suicide during the first few years after a temporal lobectomy alone, the need for continuing psychiatric observations of patients who receive an operation, especially when they have a history of postictal psychosis prior to surgery, is apparent.

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Anxiety and Depression 101

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