Skip to main content

Advertisement

SpringerLink
Log in

Update on the Epidemiology, Diagnosis, and Treatment of Mania in Older-Age Bipolar Disorder

  • Geriatric Disorders (W McDonald, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The population over age 60 is growing more rapidly than the general population. Given the projected increase and need for data that can inform treatment, this review provides a brief description of newer publications focused on mania in older-age bipolar disorder (OABD), including epidemiology, diagnosis, and treatments.

Recent Findings

Age cutoffs to define OABD range from 50 to 65 years. OABD clinical presentation and course of illness is highly variable, often characterized by mood episode recurrence, medical comorbidity, cognitive deficits, and impaired functioning. There is little pharmacotherapy data on mania in OABD. Lithium and valproate have been tested in a single randomized controlled trial and there is data of more limited quality with other compounds.

Summary

Treating OABD is challenging due to medical complexity, comorbidity, diminished tolerance to treatment, and a limited evidence base. More data is needed to keep pace with clinical demand.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. World Population Ageing: 1950–2050. United Nations, Population Division DoEaSA.

  2. World Health Organization. http://www.who.int/mediacentre/factsheets/fs381/en/. Accessed January 14 2016.

  3. • Sajatovic M, Strejilevich SA, Gildengers AG, Dols A, Al Jurdi RK, Forester BP, et al. A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force. Bipolar Disord. 2015;17(7):689–704. doi:10.1111/bdi.12331. This recently published report, resulting from a task force of the International Society for Bipolar Disorders (ISBD), addresses the unique aspects of OABD including epidemiology and clinical features, neuropathology and biomarkers, physical health, cognition, and care approaches. The report describes an expert consensus summary on OABD that is intended to advance the care of patients and shed light on issues relevant to BD research across the life span.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sajatovic M, Chen P. Geriatric bipolar disorder. Psychiatr Clin North Am. 2011;34(2):319–333, vii. doi:10.1016/j.psc.2011.02.007.

    Article  PubMed  Google Scholar 

  5. Depp CA, Jeste DV. Bipolar disorder in older adults: a critical review. Bipolar Disord. 2004;6(5):343–67. doi:10.1111/j.1399-5618.2004.00139.x.

    Article  PubMed  Google Scholar 

  6. Sajatovic M, Chen P. Geriatric bipolar disorder: epidemiology, clinical features, assessment, and diagnosis. Philadelphia: Wolters Kluwer Health. https://www.uptodate.com. Accessed Feb 2017

  7. Tariot PN, Podgorski CA, Blazina L, Leibovici A. Mental disorders in the nursing home: another perspective. Am J Psychiatry. 1993;150(7):1063–9. doi:10.1176/ajp.150.7.1063.

    Article  CAS  PubMed  Google Scholar 

  8. Depp CA, Lindamer LA, Folsom DP, Gilmer T, Hough RL, Garcia P, et al. Differences in clinical features and mental health service use in bipolar disorder across the lifespan. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2005;13(4):290–8. doi:10.1176/appi.ajgp.13.4.290.

    Article  Google Scholar 

  9. • Dols A, Kupka RW, van Lammeren A, Beekman AT, Sajatovic M, Stek ML. The prevalence of late-life mania: a review. Bipolar Disord. 2014;16(2):113–8. doi:10.1111/bdi.12104. The overall prevalence of late-life mania was estimated to be 6.0% in the reported 1519 older psychiatric inpatients from six studies. In elderly inpatients with bipolar disorder, the mean prevalence of late-onset mania was 44.2%. For other relevant care facilities, no firm conclusions could be drawn. Late-life mania is not rare in older psychiatric inpatients and late-onset mania is associated with increased somatic comorbidity in patients aged 50 years and older.

    Article  PubMed  Google Scholar 

  10. Prakash O, Kumar CN, Shivakumar PT, Bharath S, Varghese M. Clinical presentation of mania compared with depression: data from a geriatric clinic in India. Int Psychogeriatr/IPA. 2009;21(4):764–7. doi:10.1017/S1041610209009466.

    Article  Google Scholar 

  11. Preville M, Boyer R, Grenier S, Dube M, Voyer P, Punti R, et al. The epidemiology of psychiatric disorders in Quebec’s older adult population. Can J Psychiatry. 2008;53(12):822–32. doi:10.1177/070674370805301208.

    Article  PubMed  Google Scholar 

  12. Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS, et al. Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry. 2009;66(7):785–95. doi:10.1001/archgenpsychiatry.2009.36.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Angst J, Gamma A, Sellaro R, Lavori PW, Zhang H. Recurrence of bipolar disorders and major depression. A life-long perspective. Eur Arch Psychiatry Clin Neurosci. 2003;253(5):236–40. doi:10.1007/s00406-003-0437-2.

    Article  PubMed  Google Scholar 

  14. Al Jurdi RK, Marangell LB, Petersen NJ, Martinez M, Gyulai L, Sajatovic M. Prescription patterns of psychotropic medications in elderly compared with younger participants who achieved a “recovered” status in the systematic treatment enhancement program for bipolar disorder. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2008;16(11):922–33. doi:10.1097/JGP.0b013e318187135f.

    Article  Google Scholar 

  15. Oostervink F, Boomsma MM, Nolen WA, Board EA. Bipolar disorder in the elderly; different effects of age and of age of onset. J Affect Disord. 2009;116(3):176–83. doi:10.1016/j.jad.2008.11.012.

    Article  PubMed  Google Scholar 

  16. Kupka RW, Luckenbaugh DA, Post RM, Leverich GS, Nolen WA. Rapid and non-rapid cycling bipolar disorder: a meta-analysis of clinical studies. J Clin Psychiatry. 2003;64(12):1483–94.

    Article  PubMed  Google Scholar 

  17. Cruz N, Vieta E, Comes M, Haro JM, Reed C, Bertsch J, et al. Rapid-cycling bipolar I disorder: course and treatment outcome of a large sample across Europe. J Psychiatr Res. 2008;42(13):1068–75. doi:10.1016/j.jpsychires.2007.12.004.

    Article  CAS  PubMed  Google Scholar 

  18. Almeida OP, McCaul K, Hankey GJ, Yeap BB, Golledge J, Flicker L. Risk of dementia and death in community-dwelling older men with bipolar disorder. Br J Psychiatry J Ment Sci. 2016;209(2):121–6. doi:10.1192/bjp.bp.115.180059.

    Article  Google Scholar 

  19. Almeida OP, Fenner S. Bipolar disorder: similarities and differences between patients with illness onset before and after 65 years of age. Int Psychogeriatr/IPA. 2002;14(3):311–22.

    Article  Google Scholar 

  20. Azorin JM, Kaladjian A, Adida M, Fakra E. Late-onset bipolar illness: the geriatric bipolar type VI. CNS Neurosci Ther. 2012;18(3):208–13. doi:10.1111/j.1755-5949.2011.00255.x.

    Article  PubMed  Google Scholar 

  21. Vasudev A, Thomas A. ‘Bipolar disorder’ in the elderly: what’s in a name? Maturitas. 2010;66(3):231–5. doi:10.1016/j.maturitas.2010.02.013.

    Article  PubMed  Google Scholar 

  22. Goldstein BI, Herrmann N, Shulman KI. Comorbidity in bipolar disorder among the elderly: results from an epidemiological community sample. Am J Psychiatry. 2006;163(2):319–21. doi:10.1176/appi.ajp.163.2.319.

    Article  PubMed  Google Scholar 

  23. Burt T, Prudic J, Peyser S, Clark J, Sackeim HA. Learning and memory in bipolar and unipolar major depression: effects of aging. Neuropsychiatry Neuropsychol Behav Neurol. 2000;13(4):246–53.

    CAS  PubMed  Google Scholar 

  24. Broadhead J, Jacoby R. Mania in old age: a first prospective study. Int J Geriatr Psychiatry. 1990;5:215–22.

    Article  Google Scholar 

  25. Young RC, Kiosses D, Heo M, Schulberg HC, Murphy C, Klimstra S, et al. Age and ratings of manic psychopathology. Bipolar Disord. 2007;9(3):301–4. doi:10.1111/j.1399-5618.2007.00393.x.

    Article  PubMed  Google Scholar 

  26. Forester BP, Ajilore O, Spino C, Lehmann SW. Clinical characteristics of patients with late life bipolar disorder in the community: data from the NNDC registry. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2015;23(9):977–84. doi:10.1016/j.jagp.2015.01.001.

    Article  Google Scholar 

  27. Gildengers AG, Butters MA, Seligman K, McShea M, Miller MD, Mulsant BH, et al. Cognitive functioning in late-life bipolar disorder. Am J Psychiatry. 2004;161(4):736–8. doi:10.1176/appi.ajp.161.4.736.

    Article  PubMed  Google Scholar 

  28. Tsai SY, Lee HC, Chen CC, Huang YL. Cognitive impairment in later life in patients with early-onset bipolar disorder. Bipolar Disord. 2007;9(8):868–75. doi:10.1111/j.1399-5618.2007.00498.x.

    Article  PubMed  Google Scholar 

  29. Samame C, Martino DJ, Strejilevich SA. A quantitative review of neurocognition in euthymic late-life bipolar disorder. Bipolar Disord. 2013;15(6):633–44. doi:10.1111/bdi.12077.

    Article  PubMed  Google Scholar 

  30. Kessing LV, Nilsson FM. Increased risk of developing dementia in patients with major affective disorders compared to patients with other medical illnesses. J Affect Disord. 2003;73(3):261–9.

    Article  PubMed  Google Scholar 

  31. Sajatovic M, Blow FC, Ignacio RV. Psychiatric comorbidity in older adults with bipolar disorder. Int J Geriatr Psychiatry. 2006;21(6):582–7. doi:10.1002/gps.1527.

    Article  PubMed  Google Scholar 

  32. Wu KY, Chang CM, Liang HY, Wu CS, Chia-Hsuan Wu E, Chen CH, et al. Increased risk of developing dementia in patients with bipolar disorder: a nested matched case-control study. Bipolar Disord. 2013;15(7):787–94. doi:10.1111/bdi.12116.

    Article  PubMed  Google Scholar 

  33. Gildengers AG, Mulsant BH, Begley A, Mazumdar S, Hyams AV, Reynolds Iii CF, et al. The longitudinal course of cognition in older adults with bipolar disorder. Bipolar Disord. 2009;11(7):744–52. doi:10.1111/j.1399-5618.2009.00739.x.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Schouws SN, Comijs HC, Dols A, Beekman AT, Stek ML. Five-year follow-up of cognitive impairment in older adults with bipolar disorder. Bipolar Disord. 2016;18(2):148–54. doi:10.1111/bdi.12374.

    Article  PubMed  Google Scholar 

  35. Lolich M, Holtzman JN, Rago CM, Vazquez GH. Neuroprogression and cognition in bipolar disorders: a systematic review of cognitive performance in euthymic patients. Vertex. 2015;26(122):265–75.

    PubMed  Google Scholar 

  36. • Rise IV, Haro JM, Gjervan B. Clinical features, comorbidity, and cognitive impairment in elderly bipolar patients. Neuropsychiatr Dis Treat. 2016;12:1203–13. doi:10.2147/NDT.S100843. This systematic review described clinical characteristics, comorbidities, and cognitive impairment in patients with late-life BD. Cardiovascular and respiratory conditions, type II diabetes, and endocrinological abnormalities were observed as highly prevalent. BD is associated with a high suicide risk. Bipolar elderly had an increased risk of dementia and performed worse on cognitive screening tests compared to age-matched controls across different levels of cognition.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Cassidy F, Ahearn EP, Carroll BJ. Substance abuse in bipolar disorder. Bipolar Disord. 2001;3(4):181–8.

    Article  CAS  PubMed  Google Scholar 

  38. Dols A, Rhebergen D, Beekman A, Kupka R, Sajatovic M, Stek ML. Psychiatric and medical comorbidities: results from a bipolar elderly cohort study. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2014;22(11):1066–74. doi:10.1016/j.jagp.2013.12.176.

    Article  Google Scholar 

  39. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) study. JAMA. 1990;264(19):2511–8.

    Article  CAS  PubMed  Google Scholar 

  40. Sajatovic M, Kessing LV. Bipolar disorder in the elderly. In: Yatham LN, Maj M, editors. Bipolar Disorder: CLinical and Neurobiological Foundations. West Sussex: Wiley-Blackwell; 2010. p. 488.

    Chapter  Google Scholar 

  41. Yassa R, Nair V, Nastase C, Camille Y, Belzile L. Prevalence of bipolar disorder in a psychogeriatric population. J Affect Disord. 1988;14(3):197–201.

    Article  CAS  PubMed  Google Scholar 

  42. Beyer JL, Kuchibhatla M, Cassidy F, Krishnan KR. Stressful life events in older bipolar patients. Int J Geriatr Psychiatry. 2008;23(12):1271–5. doi:10.1002/gps.2062.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Depp CA, Davis CE, Mittal D, Patterson TL, Jeste DV. Health-related quality of life and functioning of middle-aged and elderly adults with bipolar disorder. J Clin Psychiatry. 2006;67(2):215–21.

    Article  PubMed  Google Scholar 

  44. Depp CA, Mausbach BT, Eyler LT, Palmer BW, Cain AE, Lebowitz BD, et al. Performance-based and subjective measures of functioning in middle-aged and older adults with bipolar disorder. J Nerv Ment Dis. 2009;197(7):471–5. doi:10.1097/NMD.0b013e3181ab5c9b.

    Article  PubMed  Google Scholar 

  45. Beyer JL, Kuchibhatla M, Looney C, Engstrom E, Cassidy F, Krishnan KR. Social support in elderly patients with bipolar disorder. Bipolar Disord. 2003;5(1):22–7.

    Article  PubMed  Google Scholar 

  46. Martire LM, Hinrichsen GA, Morse JQ, Reynolds CF 3rd, Gildengers AG, Mulsant BH, et al. The Mood Disorder Burden Index: a scale for assessing the burden of caregivers to adults with unipolar or bipolar disorder. Psychiatry Res. 2009;168(1):67–77. doi:10.1016/j.psychres.2008.04.010.

    Article  PubMed  PubMed Central  Google Scholar 

  47. • Kendler KS. The clinical features of mania and their representation in modern diagnostic criteria. Psychol Med. 2016:1–17. doi:10.1017/S0033291716003238. Clinical descriptions of mania appearing in 18 textbooks published between 1899 and 1956 were reviewed and compared to the criteria for mania from six modern operationalized diagnostic systems. Twenty-two prominent symptoms and signs were reported by five or more authors. Two symptoms (elevated mood and grandiosity) and four signs (hyperactivity, pressured speech, irritability, and new activities with painful consequences) were reported by every author. A strong relationship was seen between the frequency with which the clinical features was reported and the likelihood of their inclusion in modern diagnostic systems. However, many symptoms and signs including impulsivity, hypersexuality, mood lability, altered moral standards, increased humor, hypergraphia, and a vigorous physical appearance were not included in any modern criteria. Indeed, DSM-5 contains only eight of the historically noted clinical features. We conclude that modern operationalized criteria for mania well reflect symptoms and signs frequently reported by historical experts. This suggests that the clinical construct of mania has been relatively stable in western psychiatry since the turn of the twentieth century. However, many useful clinical features of mania described in these textbooks are missing from these criteria thereby illustrating the limitations of clinical evaluations restricted to the assessment of the only current diagnostic criteria. The disorders we study and treat are considerably richer clinically than are reflected in the DSM criteria which we use to diagnose them .

  48. Kendler KS. The clinical features of mania and their representation in modern diagnostic criteria. Psychol Med. 2017;47(6):1013–29. doi:10.1017/S0033291716003238.

    Article  CAS  PubMed  Google Scholar 

  49. • Machado-Vieira R, Luckenbaugh DA, Ballard ED, Henter ID, Tohen M, Suppes T, et al. Increased activity or energy as a primary criterion for the diagnosis of bipolar mania in DSM-5: findings from the STEP-BD Study. Am J Psychiatry. 2017;174(1):70–76. The authors compared prevalence, clinical characteristics, validators, and outcome in patients meeting the DSM-5 criteria (i.e., DSM-IV criteria plus the DSM-5 criterion of increased activity or energy) and those who did not meet the new DSM-5 criterion (i.e., who only met DSM-IV criteria). All 4360 participants met the DSM-IV criteria for bipolar disorder, and 310 met the DSM-IV criteria for a manic or hypomanic episode. When the new DSM-5 criterion of increased activity or energy was added as a coprimary symptom, the prevalence of mania and hypomania was reduced. Although minor differences were noted in clinical and concurrent validators, no changes were observed in longitudinal outcomes. CONCLUSIONS: The findings confirm that including increased activity or energy as part of DSM-5 criterion A decreases the prevalence of manic and hypomanic episodes but does not affect longitudinal clinical outcomes. doi:10.1176/appi.ajp.2016.15091132.

    Article  PubMed  Google Scholar 

  50. Kilbourne AM, Cornelius JR, Han X, Pincus HA, Shad M, Salloum I, et al. Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disord. 2004;6(5):368–73. doi:10.1111/j.1399-5618.2004.00138.x.

    Article  PubMed  Google Scholar 

  51. Perron BE, Howard MO, Nienhuis JK, Bauer MS, Woodward AT, Kilbourne AM. Prevalence and burden of general medical conditions among adults with bipolar I disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2009;70(10):1407–15. doi:10.4088/JCP.08m04586yel.

    Article  PubMed  Google Scholar 

  52. Lehmann SW, Rabins PV. Factors related to hospitalization in elderly manic patients with early and late-onset bipolar disorder. Int J Geriatr Psychiatry. 2006;21(11):1060–4. doi:10.1002/gps.1607.

    Article  PubMed  Google Scholar 

  53. Krauthammer C, Klerman GL. Secondary mania: manic syndromes associated with antecedent physical illness or drugs. Arch Gen Psychiatry. 1978;35(11):1333–9.

    Article  CAS  PubMed  Google Scholar 

  54. Van Gerpen MW, Johnson JE, Winstead DK. Mania in the geriatric patient population: a review of the literature. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 1999;7(3):188–202.

    Article  Google Scholar 

  55. Brooks JO 3rd, Hoblyn JC. Secondary mania in older adults. Am J Psychiatry. 2005;162(11):2033–8. doi:10.1176/appi.ajp.162.11.2033.

    Article  PubMed  Google Scholar 

  56. Puryear LJ, Kunik ME, Workman R Jr. Tolerability of divalproex sodium in elderly psychiatric patients with mixed diagnoses. J Geriatr Psychiatry Neurol. 1995;8(4):234–7. doi:10.1177/089198879500800407.

    Article  CAS  PubMed  Google Scholar 

  57. Woodward M, Jacova C, Black SE, Kertesz A, Mackenzie IR, Feldman H, et al. Differentiating the frontal variant of Alzheimer’s disease. Int J Geriatr Psychiatry. 2010;25(7):732–8. doi:10.1002/gps.2415.

    Article  PubMed  Google Scholar 

  58. Staekenborg SS, Su T, van Straaten EC, Lane R, Scheltens P, Barkhof F, et al. Behavioural and psychological symptoms in vascular dementia; differences between small- and large-vessel disease. J Neurol Neurosurg Psychiatry. 2010;81(5):547–51. doi:10.1136/jnnp.2009.187500.

    Article  PubMed  Google Scholar 

  59. Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain J Neurol. 2011;134(Pt 9):2456–77. doi:10.1093/brain/awr179.

    Article  Google Scholar 

  60. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology. 1993;43(2):250–60.

    Article  CAS  PubMed  Google Scholar 

  61. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR Jr, Kawas CH, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement J Alzheimers Assoc. 2011;7(3):263–9. doi:10.1016/j.jalz.2011.03.005.

    Article  Google Scholar 

  62. • Sajatovic M, Dines P, Fuentes-Casiano E, Athey M, Cassidy KA, Sams J, et al. Asenapine in the treatment of older adults with bipolar disorder. Int J Geriatr Psychiatry. 2015;30(7):710–9. doi:10.1002/gps.4213. This was a 12-week open-label trial of asenapine in the treatment for older adults with bipolar disorder ( n = 15). The study found improvements in a variety of psychiatric symptom scales, including the brief psychiatric rating scale, the clinical global impression depression and mania subscales .

    Article  PubMed  Google Scholar 

  63. Vorspan F, Bertoux M, Brichant-Petitjean C, Dubois B, Lepine JP. Relapsing-remitting behavioural variant of frontotemporal dementia in a bipolar patient. Funct Neurol. 2012;27(3):193–6.

    PubMed  Google Scholar 

  64. Kerstein AH, Schroeder RW, Baade LE, Lincoln J, Khan AY. Frontotemporal dementia mimicking bipolar disorder. J Psychiatr Pract. 2013;19(6):498–500. doi:10.1097/01.pra.0000438190.04786.16.

    Article  PubMed  Google Scholar 

  65. Cerami C, Marcone A, Galimberti D, Villa C, Scarpini E, Cappa SF. From genotype to phenotype: two cases of genetic frontotemporal lobar degeneration with premorbid bipolar disorder. J Alzheimers Dis. 2011;27(4):791–7. doi:10.3233/JAD-2011-110788.

    CAS  PubMed  Google Scholar 

  66. Pavlovic A, Marley J, Sivakumar V. Development of frontotemporal dementia in a case of bipolar affective disorder: is there a link? BMJ Case Rep. 2011; doi:10.1136/bcr.09.2010.3303.

  67. Lois G, Linke J, Wessa M. Altered functional connectivity between emotional and cognitive resting state networks in euthymic bipolar I disorder patients. PLoS One. 2014;9(10):e107829. doi:10.1371/journal.pone.0107829.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  68. Rashid B, Damaraju E, Pearlson GD, Calhoun VD. Dynamic connectivity states estimated from resting fMRI identify differences among schizophrenia, bipolar disorder, and healthy control subjects. Front Hum Neurosci. 2014;8:897. doi:10.3389/fnhum.2014.00897.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Zhou J, Seeley WW. Network dysfunction in Alzheimer’s disease and frontotemporal dementia: implications for psychiatry. Biol Psychiatry. 2014;75(7):565–73. doi:10.1016/j.biopsych.2014.01.020.

    Article  PubMed  Google Scholar 

  70. Khan BK, Yokoyama JS, Takada LT, Sha SJ, Rutherford NJ, Fong JC, et al. Atypical, slowly progressive behavioural variant frontotemporal dementia associated with C9ORF72 hexanucleotide expansion. J Neurol Neurosurg Psychiatry. 2012;83(4):358–64. doi:10.1136/jnnp-2011-301883.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Meisler MH, Grant AE, Jones JM, Lenk GM, He F, Todd PK, et al. C9ORF72 expansion in a family with bipolar disorder. Bipolar Disord. 2013;15(3):326–32. doi:10.1111/bdi.12063.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Floris G, Di Stefano F, Pisanu C, Chillotti C, Murru MR, Congiu D, et al. C9ORF72 repeat expansion and bipolar disorder—is there a link? No mutation detected in a Sardinian cohort of patients with bipolar disorder. Bipolar Disord. 2014;16(6):667–8. doi:10.1111/bdi.12210.

    Article  CAS  PubMed  Google Scholar 

  73. Floris G, Borghero G, Cannas A, Stefano FD, Murru MR, Corongiu D, et al. Bipolar affective disorder preceding frontotemporal dementia in a patient with C9ORF72 mutation: is there a genetic link between these two disorders? J Neurol. 2013;260(4):1155–7. doi:10.1007/s00415-013-6833-2.

    Article  PubMed  Google Scholar 

  74. Davies RR, Kipps CM, Mitchell J, Kril JJ, Halliday GM, Hodges JR. Progression in frontotemporal dementia: identifying a benign behavioral variant by magnetic resonance imaging. Arch Neurol. 2006;63(11):1627–31. doi:10.1001/archneur.63.11.1627.

    Article  PubMed  Google Scholar 

  75. Kipps CM, Hodges JR, Hornberger M. Nonprogressive behavioural frontotemporal dementia: recent developments and clinical implications of the ‘bvFTD phenocopy syndrome’. Curr Opin Neurol. 2010;23(6):628–32. doi:10.1097/WCO.0b013e3283404309.

    Article  PubMed  Google Scholar 

  76. • Dols A, Krudop W, Moller C, Shulman K, Sajatovic M, Pijnenburg YA. Late life bipolar disorder evolving into frontotemporal dementia mimic. Neuropsychiatr Dis Treat. 2016;12:2207–12. doi:10.2147/NDT.S99229. From our neuropsychiatric outpatient clinic, we describe four cases with bipolar disorder gradually developing a clinical syndrome, including apathy, disinhibition, loss of empathy, stereotypical behavior, and compulsiveness, fulfilling the criteria for possible behavioral variant frontotemporal dementia. All cases were diagnosed with bipolar 1 disorder at least 10 years before the onset of the current symptoms, which was not due to recent mood episodes or switches of medication. In all cases, 3–7 years of follow-up yielded no progression. Repeated neuroimaging was within normal limits. Cerebrospinal fluid biomarker studies were not supportive of underlying neurodegenerative pathology. C9orf72 mutation status was negative in all cases. Symptoms fitting the criteria for possible behavioral variant frontotemporal dementia may be present in end stage of bipolar disorder. An alternative neurodegenerative nature seems unlikely based on repeated normal neuroimaging and the absence of clinical progression. Functional involvement of the frontal-subcortical networks might play a role.

    Article  PubMed  PubMed Central  Google Scholar 

  77. • Mendez MF. Mania in neurologic disorders. Curr Psychiatry Rep. 2000;2(5):440–5. Neurologic disorders can produce “secondary” mania. Clinicians must distinguish secondary mania from primary, idiopathic manic-depressive illness (MBI). In addition to medical and drug-induced causes of secondary mania, neurologic causes usually develop in older patients who may lack a strong family history of MDI. Neurologic causes of mania include focal strokes in the right basotemporal or inferofrontal region, strokes or tumors in the perihypothalamic region, Huntington’s disease and other movement disorders, multiple sclerosis and other white matter diseases, head trauma, infections such as neurosyphilis and Creutzfeldt-Jakob disease, and frontotemporal dementia. Patients with new-onset mania require an evaluation that includes a thorough history, a neurologic examination, neuroimaging, and other selected tests. The management of patients with neurologic mania involves correcting the underlying disorder when possible and the judicious use of drugs such as anticonvulsant medications.

    Article  CAS  PubMed  Google Scholar 

  78. Robinson RG, Boston JD, Starkstein SE, Price TR. Comparison of mania and depression after brain injury: causal factors. Am J Psychiatry. 1988;145(2):172–8. doi:10.1176/ajp.145.2.172.

    Article  CAS  PubMed  Google Scholar 

  79. Jorge RE, Robinson RG, Starkstein SE, Arndt SV, Forrester AW, Geisler FH. Secondary mania following traumatic brain injury. Am J Psychiatry. 1993;150(6):916–21. doi:10.1176/ajp.150.6.916.

    Article  CAS  PubMed  Google Scholar 

  80. Braun CM, Larocque C, Daigneault S, Montour-Proulx I. Mania, pseudomania, depression, and pseudodepression resulting from focal unilateral cortical lesions. Neuropsychiatry Neuropsychol Behav Neurol. 1999;12(1):35–51.

    CAS  PubMed  Google Scholar 

  81. Steffens DC, Krishnan KR. Structural neuroimaging and mood disorders: recent findings, implications for classification, and future directions. Biol Psychiatry. 1998;43(10):705–12.

    Article  CAS  PubMed  Google Scholar 

  82. Abou-Saleh MT, Coppen A. Subjective side-effects of amitriptyline and lithium in affective disorders. Br J Psychiatry J Ment Sci. 1983;142:391–7.

    Article  CAS  Google Scholar 

  83. Chen ST, Altshuler LL, Melnyk KA, Erhart SM, Miller E, Mintz J. Efficacy of lithium vs. valproate in the treatment of mania in the elderly: a retrospective study. J Clin Psychiatry. 1999;60(3):181–6.

    Article  CAS  PubMed  Google Scholar 

  84. Goldberg JF, Sacks MH, Kocsis JH. Low-dose lithium augmentation of divalproex in geriatric mania. J Clin Psychiatry. 2000;61(4):304.

    Article  CAS  PubMed  Google Scholar 

  85. Murray N, Hopwood S, Balfour DJ, Ogston S, Hewick DS. The influence of age on lithium efficacy and side-effects in out-patients. Psychol Med. 1983;13(1):53–60.

    Article  CAS  PubMed  Google Scholar 

  86. Schaffer CB, Garvey M. Use of lithium in acutely manic elderly patients. Clin Gerontol J Aging Ment Health. 1984;3(1):58–60. doi:10.1300/J018v03n01_06.

    Google Scholar 

  87. Van der Velde C. Effectiveness of lithium carbonate in the treatment of manic-depressive illness. Am J Psychiatry. 1970;127(3):345–51.

    Article  PubMed  Google Scholar 

  88. Kando JC, Tohen M, Castillo J, Zarate CA Jr. The use of valproate in an elderly population with affective symptoms. J Clin Psychiatry. 1996;57(6):238–40.

    CAS  PubMed  Google Scholar 

  89. McFarland BH, Miller MR, Straumfjord AA. Valproate use in the older manic patient. J Clin Psychiatry. 1990;51(11):479–81.

    CAS  PubMed  Google Scholar 

  90. Niedermier JA, Nasrallah HA. Clinical correlates of response to valproate in geriatric inpatients. Ann Clin Psychiatry Off J Am Acad Clin Psychiatr. 1998;10(4):165–8.

    Article  CAS  Google Scholar 

  91. Noaghiul S, Narayan M, Nelson JC. Divalproex treatment of mania in elderly patients. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 1998;6(3):257–62.

    Article  CAS  Google Scholar 

  92. Sharma V, Persad E, Mazmanian D, Karunaratne K. Treatment of rapid cycling bipolar disorder with combination therapy of valproate and lithium. Can J Psychiatry. 1993;38(2):137–9.

    Article  CAS  PubMed  Google Scholar 

  93. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord. 2013;15(1):1–44. doi:10.1111/bdi.12025.

    Article  CAS  PubMed  Google Scholar 

  94. Sajatovic M, Calabrese JR, Mullen J. Quetiapine for the treatment of bipolar mania in older adults. Bipolar Disord. 2008;10(6):662–71. doi:10.1111/j.1399-5618.2008.00614.x.

    Article  CAS  PubMed  Google Scholar 

  95. Sajatovic M, Coconcea N, Ignacio RV, Blow FC, Hays RW, Cassidy KA, et al. Aripiprazole therapy in 20 older adults with bipolar disorder: a 12-week, open-label trial. J Clin Psychiatry. 2008;69(1):41–6.

    Article  CAS  PubMed  Google Scholar 

  96. Baruch Y, Tadger S, Plopski I, Barak Y. Asenapine for elderly bipolar manic patients. J Affect Disord. 2013;145(1):130–2. doi:10.1016/j.jad.2012.05.027.

    Article  CAS  PubMed  Google Scholar 

  97. Madhusoodanan S, Brenner R, Araujo L, Abaza A. Efficacy of risperidone treatment for psychoses associated with schizophrenia, schizoaffective disorder, bipolar disorder, or senile dementia in 11 geriatric patients: a case series. J Clin Psychiatry. 1995;56(11):514–8.

    CAS  PubMed  Google Scholar 

  98. Shulman R, Singh A, Shulman K. Treatment of elderly institutionalized bipolar patients with clozapine. Psychopharmacol Bull. 1997;33(1):113–8.

    CAS  PubMed  Google Scholar 

  99. Sethi MA, Mehta R, Devanand DP. Gabapentin in geriatric mania. J Geriatr Psychiatry Neurol. 2003;16(2):117–20. doi:10.1177/0891988703016002010.

    Article  PubMed  Google Scholar 

  100. Cullen M, Mitchell P, Brodaty H, Boyce P, Parker G, Hickie I, et al. Carbamazepine for treatment-resistant melancholia. J Clin Psychiatry. 1991;52(11):472–6.

    CAS  PubMed  Google Scholar 

  101. • Young RC. Lithium and divalproex in the treatment of mania in older patients with bipoalr disorder: a randomized clinical trial. Am Soc Clin Psychopharmacol. 2015; Miami, Florida. This was a large 3-week RCT of valproate vs. lithium for mania and hypomania in older-age bipolar disorder patients ( n > 200). This is the only RCT for older age bipolar disorder. The authors found both lithium and valproate effective in acute mania/hypomania, with similar short-term tolerability overall American Journal Psychiatry (In Press).

  102. Bartels SJ, Pratt SI, Mueser KT, Forester BP, Wolfe R, Cather C, et al. Long-term outcomes of a randomized trial of integrated skills training and preventive healthcare for older adults with serious mental illness. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2014;22(11):1251–61. doi:10.1016/j.jagp.2013.04.013.

    Article  Google Scholar 

  103. Sajatovic M, Forester BP, Gildengers A, Mulsant BH. Aging changes and medical complexity in late-life bipolar disorder: emerging research findings that may help advance care. Neuropsychiatry (London). 2013;3(6):621–33. doi:10.2217/npy.13.78.

    Article  Google Scholar 

  104. Dols A, Sienaert P, van Gerven H, Schouws S, Stevens A, Kupka R, et al. The prevalence and management of side effects of lithium and anticonvulsants as mood stabilizers in bipolar disorder from a clinical perspective: a review. Int Clin Psychopharmacol. 2013;28(6):287–96. doi:10.1097/YIC.0b013e32836435e2.

    Article  PubMed  Google Scholar 

  105. Ng F, Mammen OK, Wilting I, Sachs GS, Ferrier IN, Cassidy F, et al. The International Society for Bipolar Disorders (ISBD) consensus guidelines for the safety monitoring of bipolar disorder treatments. Bipolar Disord. 2009;11(6):559–95. doi:10.1111/j.1399-5618.2009.00737.x.

    Article  CAS  PubMed  Google Scholar 

  106. Parikh SV, Zaretsky A, Beaulieu S, Yatham LN, Young LT, Patelis-Siotis I, et al. A randomized controlled trial of psychoeducation or cognitive-behavioral therapy in bipolar disorder: a Canadian Network for Mood and Anxiety treatments (CANMAT) study [CME]. J Clin Psychiatry. 2012;73(6):803–10. doi:10.4088/JCP.11m07343.

    Article  PubMed  Google Scholar 

  107. Kilbourne AM, Barbaresso MM, Lai Z, Nord KM, Bramlet M, Goodrich DE, et al. Improving physical health in patients with chronic mental disorders: twelve-month results from a randomized controlled collaborative care trial. J Clin Psychiatry. 2017;78(1):129–37. doi:10.4088/JCP.15m10301.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Case Western Reserve University School of Medicine, Louis Stokes Veterans Administration Medical Center, Cleveland, OH, USA

    Peijun Chen

  2. Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands

    Annemiek Dols

  3. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Soham Rej

  4. Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, QC, Canada

    Soham Rej

  5. Departments of Psychiatry and of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA

    Martha Sajatovic

Authors
  1. Peijun Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annemiek Dols
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Soham Rej
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martha Sajatovic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martha Sajatovic.

Ethics declarations

Conflict of Interest

Peijun Chen, Annemiek Dols, and Soham Rej each declare no potential conflicts of interest.

Martha Sajatovic has received grant support from Alkermes, Janssen, Pfizer, and Merck and royalties from Springer Press, Johns Hopkins University Press, and Oxford Press and served as consultant for Bracket, Pfizer, Otsuka, Sunovion, Neurocrine, Supernus, and Health Analytics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Geriatric Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, P., Dols, A., Rej, S. et al. Update on the Epidemiology, Diagnosis, and Treatment of Mania in Older-Age Bipolar Disorder. Curr Psychiatry Rep 19, 46 (2017). https://doi.org/10.1007/s11920-017-0804-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-017-0804-8

Keywords

Search

Navigation