Bipolar disorder in late life: clinical characteristics in a sample of older adults admitted for manic episode

Abstract

BackgroundAlthough manic episodes in older adults are not rare, little published data exist on late-life manic episodes. Resistance to treatment and concomitant neurological lesions are frequent correlates of elderly mania. The aim of this study was to investigate the prevalence of hospitalizations due to mania in patients older than 64 years through a period of 5 years in an Italian public psychiatric ward. Moreover, we aimed at describing clinical presentation of elderly manic episodes.MethodsA retrospective chart review was conducted in order to describe clinical presentation of 20 elderly patients hospitalized for manic episode; moreover, we compared age at onset, the presence of family history for mood disorders, psychosis and irritability between the elderly group and a matched group of 20 younger manic inpatients.ResultsSeven percent of the whole inpatient elderly people suffered from mania. Half of those patients had a mood disorder age at onset after 50 years and 5 patients were at their first manic episode. Geriatric- and adulthood mania showed similar clinical presentation but younger people had more frequently a mood disorders family history.ConclusionHalf of our older manic inpatients consisted of "classic" bipolar patients with an extension of clinical manifestations into later life; the other half of our sample was heterogeneous, even though it was not possible to identify clearly which patients may have had vascular lesions related to the onset of mania.

The prevalence of late‐life mania: a review

“…Six studies reported the relative proportion of older adults with mania in inpatient psychiatric settings . All studies were retrospective chart reviews.…”

Depressive symptoms in early‐ and late‐onset older bipolar patients compared with younger ones

“…Aside from the paucity of research in geriatric BD, many methodological problems lessen the applicability of the results to older bipolar outpatients under treatment. Most studies regarding this topic were conducted exclusively on patients with a bipolar I subtype disorder after hospitalization in psychiatry wards because of a manic episode (Kennedy et al, 2005;Sajatovic et al, 2005b;Benedetti et al, 2008;Oostervink et al, 2009;Oostervink et al, 2015). Usually a cross-sectional or retrospective design (Sajatovic et al, 2005a;Benedetti et al, 2008) were applied.…”

New Onset of Bipolar Disorder in Late Life

“…While bipolar disorder in geriatric patients remains an area of active interest among investigators, 15 there are relatively few case reports that discuss the approach to symptoms of mania in an elderly patient with no known bipolar history. Arciniegas describes a case of a 60-year-old male with new onset of impulsivity, reduced need for sleep, and labile affect who was given an initial diagnosis of late-onset bipolar disorder.…”