摘要：

Ketamine is an N-methyl-D-aspartate (NMDA) antagonist that has become increasingly recognized and utilized in the treatment of post-operative pain as a way to reduce opioid use. Overall ketamine is generally well tolerated, however it is associated with transient hypertension and neurologic "emergence phenomena" manifesting as dream-like states, irrational behavior, and delirium. From a psychiatric perspective, ketamine is known to cause mania in animal models, but evidence in humans is lacking. This report adds a fourth case of possible ketamine-induced mania to the literature, however this is the first case report of mania in a patient with no previously documented family or personal history of Bipolar Disorder. Decreased need for sleep occurred within hours of the initiation of the ketamine infusion and the symptoms of mania progressed throughout the next 3 days culminating on day 4 of ketamine therapy in a full manic episode. Well-known, post-anesthetic "emergence phenomena" after ketamine use differs from our case in that patients are generally somnolent, whereas our patient developed a manic state which took weeks to resolve with olanzapine and lorazepam treatment. This patient was off treatment and symptom free for more than a year before developing a second manic episode and subsequently being diagnosed with Bipolar Disorder. As ketamine is being increasingly used in psychiatric and non psychiatric populations, all providers should be aware of the possibility of an affective switch with the use of ketamine. It is unclear if ketamine can induce mania in susceptible individuals, though this case suggests that it may.

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