Older age bipolar disorder

Beunders, Alexandra J.M.; Orhan, Melis; Dols, Annemiek

doi:10.1097/yco.0000000000000883

Cited by 7 publications

(5 citation statements)

References 97 publications

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“…Closer follow-up in the community may also be beneficial for this population as elderly individuals have frailty, impaired functioning, and 1.5–2-fold higher mortality risk [ 15 ]. It is recommended that clinicians should approach the treatment of bipolar disorder in the elderly with an integrative care model that aims to enhance psychosocial functioning and overall quality of life [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

From Unipolar to Bipolar: The Diagnostic Evolution in an Elderly Man

Lu,

Zhang,

Tan

et al. 2023

Case Reports in Psychiatry

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A pivotal concept in the field of mood disorders is the dichotomy between unipolar depression and bipolar disorder. Due to the unique treatment in older age bipolar disorder and the scarcity of research in this area, it is clinically important to raise the awareness of the diagnostic conversion of unipolar depression to bipolar disorder in the elderly population. We present a case of a 71-year-old Chinese man whose diagnosis was revised to bipolar disorder after 9 years of treatment for unipolar depression. Organic workup, including blood tests and brain imaging, was performed to rule out organic causes. This patient eventually responded well to the combined treatment of an antipsychotic and a mood stabilizer. This case report adds to the growing literature of challenges in identifying and managing bipolar disorder in the elderly. As unipolar depression and bipolar disorder have different disease courses and different treatment strategies, it is essential for clinicians to be aware of diagnostic conversion. Further research is needed to delineate bipolar disorder from unipolar depression in the elderly population.

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Section: Discussionmentioning

confidence: 99%

From Unipolar to Bipolar: The Diagnostic Evolution in an Elderly Man

Lu,

Zhang,

Tan

et al. 2023

Case Reports in Psychiatry

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“…However, because elderly subjects are often excluded from randomized clinical trials, studies focused on the treatment of bipolar disorder in older age are lacking and the information is mainly based on data derived from mixed age populations [48,49]. A growing attention is being given to a subset of patients with bipolar disorder, defined "older age bipolar disorder" (OABD), i.e., bipolar patients aged 50 years and over with prevalent cognitive deficits, increased risk of dementia, impaired psychosocial functioning, frequent physical comorbidities, and premature death [50,51]. In a double-blind, randomized, controlled trial in elderly patients with bipolar disorder, lithium was more effective than valproate in reducing manic symptoms during a 9 week follow-up and both drugs were similarly well tolerated [52].…”

Section: Myth 1: Lithium Is Not the First Choice For Treating Patient...mentioning

confidence: 99%

Facts and myths about the use of lithium for bipolar disorder in routine clinical practice: an expert consensus paper

Fiorillo,

Sampogna,

Albert

et al. 2023

Ann Gen Psychiatry

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Background Bipolar disorder is one of the most burdensome severe mental disorders, characterized by high levels of personal and social disability. Patients often need an integrated pharmacological and non-pharmacological approach. Lithium is one of the most effective treatments available not only in psychiatry, but in the whole medicine, and its clinical efficacy is superior to that of other mood stabilizers. However, a declining trend on lithium prescriptions has been observed worldwide in the last 20 years, supporting the notion that lithium is a ‘forgotten drug’ and highlighting that the majority of patients with bipolar disorder are missing out the best available pharmacological option. Based on such premises, a narrative review has been carried out on the most common “misconceptions” and “stereotypes” associated with lithium treatment; we also provide a list of “good reasons” for using lithium in ordinary clinical practice to overcome those false myths. Main text A narrative search of the available literature has been performed entering the following keywords: “bipolar disorder”, “lithium”, “myth”, “mythology”, “pharmacological treatment”, and “misunderstanding”. The most common false myths have been critically revised and the following statements have been proposed: (1) Lithium should represent the first choice for the treatment of patients with bipolar disorder; (2) lithium treatment is effective in different patients’ groups suffering from bipolar disorder; (3) Drug–drug interaction risk can be easily managed during lithium treatment; (4) The optimal management of lithium treatment includes periodical laboratory tests; (5) Slow-release lithium formulation has advantages compared to immediate release formulation; (6) Lithium treatment has antisuicidal properties; (7) Lithium can be carefully managed during pregnancy. Conclusions In recent years, a discrepancy between evidence-based recommendations and clinical practice in using lithium treatment for patients with bipolar disorder has been highlighted. It is time to disseminate clear and unbiased information on the clinical efficacy, effectiveness, tolerability and easiness to use of lithium treatment in patients with bipolar disorder. It is necessary to reinvigorate the clinical and academic discussion about the efficacy of lithium, to counteract the decreasing prescription trend of one of the most effective drugs available in the whole medicine.

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“…Those 70 years of age and older are also a growing demographic, but due to the lack of research in these oldest old, there is urgency to further study this group of OABD to guide clinical care and to provide services to meet their healthcare needs. [1][2][3][4] Bipolar disorder is likely to be multidimensional and include several subtypes with different neurobiology and comorbidities. 5,6 Age is one factor that may distinguish such subtypes of the disorder.…”

Section: Introductionmentioning

confidence: 99%

“…With the world population aging, older age bipolar disorder (OABD) is becoming more prevalent than before, and people with OABD over the age of 50 now account for 25% of people with bipolar disorder (BD). Those 70 years of age and older are also a growing demographic, but due to the lack of research in these oldest old, there is urgency to further study this group of OABD to guide clinical care and to provide services to meet their healthcare needs 1–4 …”

Section: Introductionmentioning

confidence: 99%

Sociodemographic and clinical characteristics of people with oldest older age bipolar disorder in a global sample: Results from the global aging and geriatric experiments in bipolar disorder project

Chen,

Sajatovic,

Briggs

et al. 2024

Int J Geriat Psychiatry

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ObjectsStudies of older age bipolar disorder (OABD) have mostly focused on “younger old” individuals. Little is known about the oldest OABD (OOABD) individuals aged ≥70 years old. The Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE‐BD) project provides an opportunity to evaluate the OOABD group to understand their characteristics compared to younger groups.MethodsWe conducted cross‐sectional analyses of the GAGE‐BD database, an integrated, harmonized dataset from 19 international studies. We compared the sociodemographic and clinical characteristics of those aged <50 (YABD, n = 184), 50–69 (OABD, n = 881), and ≥70 (OOABD, n = 304). To standardize the comparisons between age categories and all characteristics, we used multinomial logistic regression models with age category as the dependent variable, with each characteristic as the independent variable, and clustering of standard errors to account for the correlation between observations from each of the studies.ResultsOOABD and OABD had lower severity of manic symptoms (Mean YMRS = 3.3, 3.8 respectively) than YABD (YMRS = 7.6), and lower depressive symptoms (% of absent = 65.4%, and 59.5% respectively) than YABD (18.3%). OOABD and OABD had higher physical burden than YABD, especially in the cardiovascular domain (prevalence = 65% in OOABD, 41% in OABD and 17% in YABD); OOABD had the highest prevalence (56%) in the musculoskeletal domain (significantly differed from 39% in OABD and 31% in YABD which didn't differ from each other). Overall, OOABD had significant cumulative physical burden in numbers of domains (mean = 4) compared to both OABD (mean = 2) and YABD (mean = 1). OOABD had the lowest rates of suicidal thoughts (10%), which significantly differed from YABD (26%) though didn't differ from OABD (21%). Functional status was higher in both OOABD (GAF = 63) and OABD (GAF = 64), though only OABD had significantly higher function than YABD (GAF = 59).ConclusionsOOABD have unique features, suggesting that (1) OOABD individuals may be easier to manage psychiatrically, but require more attention to comorbid physical conditions; (2) OOABD is a survivor cohort associated with resilience despite high medical burden, warranting both qualitative and quantitative methods to better understand how to advance clinical care and ways to age successfully with BD.

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Older age bipolar disorder

Cited by 7 publications

References 97 publications

From Unipolar to Bipolar: The Diagnostic Evolution in an Elderly Man

From Unipolar to Bipolar: The Diagnostic Evolution in an Elderly Man

Facts and myths about the use of lithium for bipolar disorder in routine clinical practice: an expert consensus paper

Sociodemographic and clinical characteristics of people with oldest older age bipolar disorder in a global sample: Results from the global aging and geriatric experiments in bipolar disorder project

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