Tailoring adult psychiatric practices to the field of geriatrics

Greenwald, Blaine S.; Kremen, Neil; Aupperle, Peter M.

doi:10.1007/bf01066763

Cited by 9 publications

(3 citation statements)

References 77 publications

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“…This is in line with more recent epidemiological studies that report a proportion of 0.5-1% of old age bipolar I and II patients [7,8]. Even higher numbers have been observed in special settings, e.g., a prevalence of 3-10% in nursing homes [9,10]. Dols and colleagues [11] report a 6% prevalence of manic episodes in elderly psychiatric inpatients, with 44% having late onset mania.…”

Section: Introduction: Epidemiology Of Bipolar Disorder In Old Age Patientssupporting

confidence: 76%

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: Introduction: Epidemiology Of Bipolar Disorder In Old Age Patientssupporting

confidence: 76%

Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment

Arnold

Dehning

Grunze³

et al. 2021

Medicina

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“…Samples that do not include elderly individuals living in nursing homes or state residential and assisted living facilities may underestimate the number meeting criteria for mania. One study estimated the prevalence of mania in nursing home residents to be as high as 10% [3] compared with the 1% to 2% prevalence in the general adult population.…”

Section: Introductionmentioning

confidence: 97%

Pharmacologic treatment of geriatric mania

McDonald¹,

Wermager²

2002

Curr Psychiatry Rep

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The prevalence of geriatric mania is uncertain. Although there are high rates of mania in clinical and residential facilities, community based epidemiologic studies are limited. Given the difficulty in making an accurate diagnosis, geriatric mania appears to be underreported. Although the commonly held opinion is that onset and prevalence of mania decreases with age, there is contradictory evidence that, particularly in men, the incidence of new onset mania increases with age. Clinically, the diagnosis and treatment of geriatric mania is challenging, because these patients present with comorbid medical, neurologic, and dementing illnesses. This paper reviews presentations of mania in the elderly and updates the pharmacologic treatment of mania in the elderly. Although few of the studies target the elderly, the published data in younger patients on the use of the atypical antipsychotics, as well as the advent of newer anticonvulsants, have demonstrated promise in the treatment of older patients.

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“…It has been estimated that 10% of new-onset mania cases occur in patients over 50 years of age (Kaplan and Sadock, 1985) and that bipolar disorder accounts for 5% to 19% of mood disorder presentations in the elderly (Cassano et al, 2000). Wylie et al (1999) reported that approximately 7% of geriatric inpatient admissions were for bipolar illness, while the Epidemiologic Catchment Area study in 1990 found that 9.7% of all nursing home patients had bipolar disorder (Greenwald et al, 1992).…”

mentioning

confidence: 99%

Bipolar Disorder in Older Adult Inpatients

Sajatovic

Bingham

Campbell

et al. 2005

Journal of Nervous &Amp; Mental Disease

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The literature on bipolar disorder in older adults is very limited, in spite of the fact that the elderly are a growing population in the United States. This retrospective record review study evaluated clinical characteristics and hospital-based resource use patterns among 48 older adults with bipolar disorder, and compared groups with early-onset (EOS) versus late-onset (LOS) bipolar disorder. The mean age of the group was 67.3 years, with no difference in age between EOS and LOS categories. Late onset illness was identified in 29.2% of the group (N = 14). Compared with individuals with EOS, individuals with LOS were 2.8 times more likely to be female. Both groups had extensive medical comorbidity (mean of 3.7 comorbid medical conditions), substantial hospital usage (mean length of stay, 14.8 days) and polypharmacy usage. Bipolar disorder with onset after age 50 is not uncommon among older adults hospitalized on a geropsychiatric unit. Clinical characteristics may differ between individuals with early-onset and late-onset bipolar illness, and resource utilization may be extensive in both groups.

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Tailoring adult psychiatric practices to the field of geriatrics

Cited by 9 publications

References 77 publications

Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment

Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment

Pharmacologic treatment of geriatric mania

Bipolar Disorder in Older Adult Inpatients

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