Older Age Bipolar Disorder

Dols, Annemiek; Beekman, Aartjan

doi:10.1016/j.cger.2019.11.008

Cited by 22 publications

(17 citation statements)

References 127 publications

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“…Despite the sparse evidence, some guidance on the management and treatment of BD in old age has been compiled, e.g., [12,[67][68][69][70]. In the absence of contradicting evidence, current guidelines concluded that first-line treatment for old age BD should be similar to that for working-age BD, with specific attention to vulnerability to side effects, somatic comorbidities and specific risks in elderly patients, e.g., usage of antipsychotics in cerebrovascular disease [71].…”

Section: Psychopharmacological Treatmentmentioning

confidence: 99%

Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment

Arnold

Dehning

Grunze³

et al. 2021

Medicina

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Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called “late onset” patients (LOBD), and the elder patients with a long-standing clinical history, the so called “early onset” patients (EOBD). The aim of the present literature review is to provide more information on specific issues concerning OABD, such as epidemiology, aetiology and treatments outcomes. We conducted a Medline literature search from 1970–2021 using the MeSH terms “bipolar disorder” and “aged” or “geriatric” or “elderly”. The additional literature was retrieved by examining cross references and by a hand search in textbooks. With sparse data on the treatment of OABD, current guidelines concluded that first-line treatment of OABD should be similar to that for working-age bipolar disorder, with specific attention to side effects, somatic comorbidities and specific risks of OABD. With constant monitoring and awareness of the possible toxic drug interactions, lithium is a safe drug for OABD patients, both in mania and maintenance. Lamotrigine and lurasidone could be considered in bipolar depression. Mood stabilizers, rather than second generation antipsychotics, are the treatment of choice for maintenance. If medication fails, electroconvulsive therapy is recommended for mania, mixed states and depression, and can also be offered for continuation and maintenance treatment. Preliminary results also support a role of psychotherapy and psychosocial interventions in old age BD. The recommended treatments for OABD include lithium and antiepileptics such as valproic acid and lamotrigine, and lurasidone for bipolar depression, although the evidence is still weak. Combined psychosocial and pharmacological treatments also appear to be a treatment of choice for OABD. More research is needed on the optimal pharmacological and psychosocial approaches to OABD, as well as their combination and ranking in an evidence-based therapy algorithm.

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Section: Psychopharmacological Treatmentmentioning

confidence: 99%

Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment

Arnold

Dehning

Grunze³

et al. 2021

Medicina

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“… 9 , 10 It is estimated that approximately 10% of individuals with OABD develop their first-onset mania episode in association with a neurovascular disorder. 3 Approximately 6% of all geriatric psychiatry outpatient visits and 8–10% of all geriatric inpatient admissions involve individuals with OABD. 11 Individuals with OABD account for approximately 17% of all older individuals undergoing psychiatric evaluation in the emergency department.…”

Section: Reviewmentioning

confidence: 99%

“…The available evidence for using specific psychotherapies for OABD is limited and often extrapolated from mixed-age studies or from anecdotal evidence. 3 Medication adherence skills training (the MAST-BD intervention) amongst individuals with OABD has been found to improve their ability to manage medications, compliance with medications, symptoms of depression and certain domains of health‐related quality of life with medium effect sizes (Cohen’s d, 0.30–0.57). 40 A manual-based medical care model was found to improve patient satisfaction rates, dropout rates and follow-up rates amongst individuals with OABD.…”

Section: Reviewmentioning

confidence: 99%

“… 2 Available evidence indicates that the number of individuals with older-age BD (OABD) is expected to increase significantly over the next few decades. 3 Available evidence indicates that the relative frequency of OABD had increased from 1% to 11% between 1980 and 1998. 4 In this review, we describe the various aspects of OABD, including the evidence-based treatment for this disorder.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation and treatment of older-age bipolar disorder: a narrative review

Tampi¹,

Joshi²,

Bhattacharya³

et al. 2021

DIC

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Objectives This narrative review aims to synthesize information from the literature regarding older-age bipolar disorder (OABD) in order to provide up-to-date information on this important illness. Methods We searched Ovid (Medline, Embase and PsychInfo) on October 1, 2020, using the keywords “bipolar disorder”, “older adults” and “elderly” to identify relevant articles on OABD. Additionally, the bibliography of identified articles was reviewed for pertinent studies. Discussions OABD is a term that is used to describe bipolar disorder (BD) occurring amongst individuals ≥50 years of age. Evidence indicates that OABD accounts for a quarter of all cases of BD. When compared to individuals with early-onset BD, individuals with OABD have a greater association with cerebrovascular disease and other neurological disorders, less family history of mood disorders, and utilize almost four times the total amount of mental health services. In addition, they are four times more likely to have psychiatric hospitalizations when compared to age-matched controls. Despite a dearth of controlled studies on the use of pharmacotherapy amongst individuals with OABD, available evidence from mixed-age studies indicates the efficacy of commonly used medications in individuals with early-onset BD. Additionally, psychosocial treatments have been found to be effective as adjunctive management strategies amongst individuals with OABD. Furthermore, electroconvulsive therapy may be effective in the treatment of refractory cases of OABD. Conclusions There is a great need for an improved understanding of the phenomenology and neurobiology of OABD. Additionally, research into effective treatments for this serious psychiatric disorder will mitigate the suffering of individuals with OABD.

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“…Scientific literature on LOBD is still scarce. However, it has been hypothesized that rising life expectancy may potentially lead to an overall increased incidence of mood disorders, including BD, in advanced ages ( 11 ). Accordingly, one could argue whether non-LOBD and LOBD in the psychogeriatric population could be distinct nosological entities, with different etiopathogenesis, psychopathology, clinical course, and treatment.…”

Section: Introductionmentioning

confidence: 99%

Depressive and Anxious Temperaments as Predictors of Late Onset Bipolar Disorder? Preliminary Results of a “Real World” Exploratory Study

et al. 2022

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IntroductionBipolar disorder (BD) onset typically occurs between 15 and 30 years, being diagnosed under the age of 50 in 90% of cases, named “non-late onset BD” (non-LOBD). However, clinical observation of late-onset BD (LOBD) raised some concern regarding a differential psychopathological pattern, outcomes and treatment, including a specific affective temperament vulnerability. Therefore, an exploratory study in the “real world” was carried out by investigating psychopathological and temperamental features of a psychogeriatric cohort of LOBD and non-LOBD subjects.MethodsA total of 180 patients affected with BD-I, BD-II, and Cyclothymic Disorder were screened in a Mood Disorder Outpatient Service, during the timeframe January 2019-August 2021. Out of 78 enrolled outpatients, 66 (33 non-LOBD, 33 LOBD) were recruited, by the retrospective collection of sociodemographic, cognitive, psychopathological and clinical assessment, including the short-version of the Temperament Evaluation of Memphis, Pisa, and San Diego (TEMPS-M).ResultsLOBD is significantly associated with higher rates of BD-II diagnosis (χ2 = 27.692, p < 0.001), depressive episodes (p = 0.025), mixed states (p = 0.009), predominant depressive and anxious affective temperaments (p < 0.001). Non-LOBD is significantly associated with higher endocrinological (χ2 = 6.988, p = 0.008) and metabolic comorbidity (χ2 = 5.987, p = 0.014), a diagnosis of BD-I, manic episodes, and predominant hyperthymic affective temperaments (p = 0.001). GDS (p < 0.001) and MSRS (p = 0.005) scores were significantly higher in LOBD.ConclusionFurther longitudinal studies with larger sample sizes and a control group are needed to determine whether LOBD may represent a distinct psychopathological entity from non-LOBD and evaluate differences (if any) in terms of prognosis and treatment between non-LOBD and LOBD.

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Older Age Bipolar Disorder

Cited by 22 publications

References 127 publications

Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment

Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment

Evaluation and treatment of older-age bipolar disorder: a narrative review

Depressive and Anxious Temperaments as Predictors of Late Onset Bipolar Disorder? Preliminary Results of a “Real World” Exploratory Study

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