All Mixed Up!! Challenges Faced and Lessons Learned in the Outpatient Management of Bipolar Disorder in Older Adults

Abstract

This session will highlight several challenging and complicated cases of bipolar disorder treated in an outpatient geriatric psychiatry clinic. We will share our lessons learned from these clinical encounters with the assistance of Dr. Tawny Smith, a clinical psychiatric pharmacist. Dr. Garcia-Pittman will provide background information regarding bipolar disorder in older adults and lead the group discussion at the conclusion of the session. Dr. Polackal will present a case highlighting how proper recognition of mixed features lead to a new diagnosis of late life bipolar disorder. Dr. Polackal will provide guidance for accurate screening and diagnosis of mixed symptoms, focusing on how these symptoms can present differently in the geriatric patient. She will then discuss treatment, focusing on recent literature updates. Dr. Bovio will discuss a case of a patient with bipolar I disorder treated on dual therapy with valproic acid and quetiapine. Dr. Bovio will discuss management considerations when using valproic acid in older adults and the available evidence for the use of dual agents. Dr. Donley will present a clinical case highlighting the use of cariprazine in a patient with bipolar disorder. He will focus on consequences of rapid dose escalation, and review clinical pearls related to the unique mechanism, pharmacokinetics, and further treatment considerations in older adults. Dr. Good will discuss a case of a patient with newly diagnosed bipolar disorder with mixed features who achieved early remission of symptoms with lithium until experiencing lithium toxicity subsequent to a COVID-19 infection. He will review challenges associated with managing patients on lithium in a virtual outpatient clinic during the COVID-19 pandemic and discuss additional clinical factors to consider for patients on lithium who are diagnosed with COVID-19. Dr. Smith will review clinical pearls related to the cases presented. In addition, we will share knowledge regarding literature updates, as well as guidelines for treatment of the aging patient with bipolar disorder.