Monday, 18 August 2003: 09:00-10:30
Michigan Room (Sheraton Hotel and Towers)

S004 Bipolar Disorders in Old Age

Mania and bipolar (BP) disorders in old age comprise a significant subgroup of geropsychiatric patients. They present multiple challenges to treatment services. Information useful to clinicians has accumulated gradually. We review current approaches and findings that can guide design of studies intended to enhance treatment and to provide direction for clinicians. The psychopathologic features of manic states in the elderly can be severe and disruptive, and can include aggression and lack of insight. Psychotic features can be present, and cognitive impairments are common. Dementia and delirium can present as mania. Substance abuse and provocative medical conditions and treatments need to be identified and managed. Longitudinal assessment can be critical to diagnosis. Manic episodes can present first in late life or can be recurrent. In contrast to experience in young BP patients, average age at onset is late; first depressive episode typically predates first manic episode. Medical and neurological comorbidity is common. Patients are at risk for recurrence and increased mortality. Neurological comorbidity can be associated with poor outcome. Acute treatment is organized around mood stabilizers, primarily lithium and divalproex, but there are no controlled comparisons published. Optimal dosing and plasma concentrations are not defined, and toxicity may limit adequate treatment. Functional outcomes have not been studied. Criteria for adjunctive antipsychotic or antidepressant pharmacotherapy, and their optimal doses and duration, have not been studied in geriatric BP disorders. There are also no data on approaches to partial responders or on continuation/maintenance management. Electroconvulsive therapy can be safe and effective but guidelines for use are needed. Aged BP patients often have limited social support, which has implications for long term care needs and for adherence to management; impaired social support is associated with worse outcomes in elderly unipolar depressed patients. The role of psychoeducation for patients, families and caregivers has not been tested. New laboratory methods, including neuroimaging, are anticipated to contribute to studies aimed at improved clinical care. Mood stabilizers may have positive effects on brain structure; these effects might be particularly relevant to aged BP patients. In summary, clinicians need to be alert to BP disorders in the assessment of elders with mood disorder. They should conduct a thorough medical/neurological review, particularly in late onset cases. Treatment of manic features should include mood stabilizers, and adjuncts and alternatives. Attention to social support issues is necessary for adequate management. Characteristics of late life BP disorders offer strategies for studies that can improve treatment in this underserved population, including randomized controlled trials, multi-center approaches, and focus on cognitive/neurological impairments as potential modifiers of outcomes.
Chair:Robert C. Young
 S004-001 Presentation and Diagnosis of Late Life Bipolar Disorder
Robert C. Young
 S004-002 Comorbidities and Outcomes in Late Life Mania
Kenneth I. Shulman
 S004-003 The Correlates of Cognitive Dysfunction in Early-Onset Elderly Bipolar Patients
Shang-Ying Tsai, Hsin-Chien Lee, Chi-Yung Shang, Chiao-Chicy Chen
 S004-004 Pharmacotherapy of Late-Life Bipolar Disorder
B Mulsant
 S004-005 Social Support and Stressful Life Events in Older Adults with Bipolar Disorder
John Beyer
 S004-006 Well-Being and Functioning in Bipolar Disorder: How Much Do We Know About the Elderly?
Laszlo Gyulai

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