Mania In Old Age Research Articles

Old Age Bipolar Disorder-Epidemiology, Aetiology and Treatment.

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.

P01-180 Mania in old age: A case report

Background:Geriatric bipolar disorder is associated with a significant morbidity, mortality and poor psychosocial outcomes. Bipolar affective disorder contributes substantially to geriatric mood disorders and to geriatric hospitalizations. Mania in late-life is often a tremendous treatment challenge because of frequent medical co-morbidity and age-related variations in response to therapeutics.Aim:To report a case of mania in late-life, in order to discuss the impact of bipolar disorder in the elderly, underlining treatment difficulties in the geriatric population.Methods:Case study and review of the literature.Results:A 70 year old woman was hospitalized in a geriatric service of a psychiatric hospital with a maniac episode. She had a history of bipolar disorder diagnosed during her adult life. She had several co-morbid medical conditions, including diabetes, hypertension, dyslipidemia and psoriasis. There was a successful multidisciplinary approach and intervention, allowing a significant improvement and reintegration in the community.Conclusions:Geriatric patients with bipolar disorder carry a substantial burden of general medical conditions. There are few studies and a lack of specific algorithms concerning bipolar management in the elderly. It is urgent the development of specific interventions that target medical burden in patients with bipolar disorder and further research on the treatment of bipolar disorder in old age. A multidisciplinary approach is essential to allow a holistic treatment and improvement of quality of life parameters in this population.

Frontal Signal Hyperintensities in Mania in Old Age

Signal hyperintensities (SH) on magnetic resonance (MR) imaging have been associated with increased age and with mood disorders. Frontal and subcortical neuropathology has been implicated in the pathophysiology of mania and bipolar disorders. The authors assessed frontal and subcortical SH in elderly bipolar manic patients and the comparison group, and hypothesized that SH scores would be greater in the patient group. MR imaging was performed in patients aged > or = 60 years with bipolar disorder, mania, and in a same-aged community comparison group. SH were rated blindly using the Boyko system. Frontal deep white matter and basal ganglia SH were assessed in the left and right hemispheres. SH scores were significantly greater in patients (N = 40) than the comparison group (N = 15) in frontal deep white matter (left: p = 0.003; right: p = 0.023) based on Mann-Whitney two-sample exact tests. The SH scores in the subcortical gray regions overlapped in these groups. In patients, higher right frontal SH scores were associated with later age at onset of mania. Frontal deep white matter SH may be increased in elders with bipolar disorder. Further study of the relationship of SH to age at onset in elders is warranted.

Mania in old age

Mania in old age

PATHOGENESIS AND ETIOLOGY OF MANIA IN OLD AGE

This paper reviews literature that reveals a high prevalence of heterogeneous neurologic disorders in elderly bipolar patients. These include cerebrovascular lesions, head trauma, and brain tumors among other systemic and neurologic conditions. Many of these late-onset bipolar patients appear to meet criteria for the concept of “secondary mania”; hence the integration of data on mania in old age from the neurological literature is especially relevant. The neurological literature has focused on disinhibition syndromes and cases of secondary mania in association with lesions lateralized to the right hemisphere of the brain and localized to the orbitofrontal and basotemporal cortex. These brain regions, functionally connected to the frontal and limbic systems, are known as the orbitofrontal circuit (OFC). The neurologic comorbidity found in elderly bipolar patients helps to establish a framework for understanding the pathogenesis of mania in old age. The evidence suggests that individuals with an “affective vulnerability” who suffer specific brain pathology involving the OFC may be particularly prone to develop late-onset mania. These findings in old age may also help to elucidate the pathogenesis of biopolar disorders in younger populations.

THE NATURE AND MANAGEMENT OF MANIA IN OLD AGE

Mania in old age represents a syndrome involving affective vulnerability in association with neurologic lesions that affect specific areas of the brain. Most patients suffering from mania in late life have converted to bipolarity later in life after many years and often repeated episodes of depression or else have developed mania in association with specific neurologic insults, particularly cerebrovascular disease (vascular mania). The outcome is generally worse in mania than in depression with higher prevalence of cognitive dysfunction, persistent symptoms, and greater mortality. The management of elderly bipolar patients with mood stabilizers reflects the experience with a mixed age population primarily involving the use of lithium carbonate and valproate in appropriately adjusted dosages and serum levels, with valproate having an edge on better tolerability. The use of neuroleptics is often unavoidable in initial stabilization, and electroconvulsive therapy can be life-saving in severely overactive or refractory patients.

Disinhibition syndromes, secondary mania and bipolar disorder in old age

Background: The neurological literature concerning disinhibition syndromes and secondary mania has run in parallel to clinical reports of bipolar disorder in old age. Methods: A critical review was conducted of both the neurological and geriatric psychiatry literature in an attempt to integrate the two streams. Results: Disinhibition syndromes include lateralization to the right hemisphere and localization of lesions to the orbito-frontal and basotemporal cortex involving limbic and frontal connections (orbito-frontal circuit). Mania in old age is associated with late onset, heterogeneous neurological disorders and poor outcome. Conclusion: Bipolar disorders in old age may be understood in the context of affective vulnerability influenced by a specific neurobiologic substrate. Limitations: The clinical literature consists predominantly of small case series and anecdotal reports. Clinical relevance: Improved understanding of these syndromes may elucidate the pathogenesis and etiology of bipolar disorders and the neuropsychiatric syndromes affecting mood, motivation and behavioural disinhibition.

Recent developments in the epidemiology, co-morbidity and outcome of mania in old age

Recent developments in the epidemiology, co-morbidity and outcome of mania in old age

The significance of mania in old age

The significance of mania in old age

A First Episode of Mania After Age 80

The case of a patient whose first episode of mania (DSM-III-R diagnosis) occurred after age 80 is presented; the patient had no previous psychiatric illness. Diagnostic and therapeutic issues are discussed with special regard to features of mania in old age, secondary mania (organic mood syndrome), pseudodementia, MHPG excretion and carbamazepine treatment.

Mania in old age: A First Prospective Study

AbstractIn a first prospective study of manic illness in old age, 35 manic patients over the age of 60 were compared with 35 patients below the age of 40 on clinical and cognitive measures. CT scan comparisons were made between the elderly patients and age‐matched healthy controls. Contrary to previously accepted teaching, the elderly were effectively clinically indistinguishable from the younger patients, except that the latter experienced more severe illnesses. CT and cognitive results, however, in the elderly group showed evidence of changes which support the view that cerebral organic factors play an important role in the genesis of affective disorder in old age.

Late-Onset Bipolar Disorder

Mania in old age is not as rare as it was once thought to be. It may constitute up to 5 per cent of admissions in the psychogeriatric department. The clinical picture, for the most part, seems to correspond with mania in younger patients, although some patients may have atypical presentations. Secondary mania should be excluded first, before a firm diagnosis of primary affective disorder is made. The prognosis and treatment of late onset mania do not seem to differ appreciably from those in younger patients.