Mania with mixed symptoms arising in a woman with CADASIL

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an autosomal dominantly inherited angiopathy due to NOTCH3 gene mutations. We describe a case involving a 49-year-old woman with sequence-confirmed CADASIL who was admitted psychiatrically following a serious suicide attempt, and who was later determined to have dysphoric or mixed manic symptoms, arising in the setting of antidepressant and stimulant treatment. After a dramatic and complicated clinical course, the patient exhibited robust response to lithium and a typical antipsychotic agent. This case report suggests an approach to the management of manic symptoms in persons with CADASIL.