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A Comprehensive Review of the Evaluation, Diagnosis, and Treatment of Older Adult Bipolar Disorder

  • Geriatric Disorders (M Sajatovic and A Aftab, Section Editors)
  • Published:
Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Abstract

Purpose of review

This review summarizes the extant literature on the epidemiology, neuropsychology, clinical assessment, and treatment/management of older adult bipolar disorder (OABD). The primary aim was to provide a contemporary and accessible reference for clinicians involved in the care of OABD patients.

Recent findings

Important research into the unique features of OABD has been carried out in recent years, providing a more robust albeit still limited foundation to help guide clinical decision-making. Some of the more consistent findings have highlighted (1) the importance of assessing for potentially reversible sources of secondary mania (i.e., manic symptoms unrelated to a primary mood disorder but with qualitatively similar presentation) in patients with late-onset mania; (2) the need for closer follow-up and more aggressive treatment to help stabilize illness course in OABD patients with earlier symptom onset; (3) the presence of domain-general cognitive dysfunction (but not accelerated cognitive aging) in OABD; and (4) the strong need for more randomized control trials examining the safety and efficacy of various psychopharmacological interventions in OABD samples. Research continues to support lithium as the gold-standard treatment for OABD, but there are other promising therapies. Asenapine, lurasidone, and divalproex have demonstrated efficacy in reducing symptoms, but future research must also categorize their side effect profile and most effective use in treatment (e.g., monotherapy or adjunctive therapy). ECT may be a useful alternative to pharmacotherapy, but very little research has been conducted in the OABD patient population.

Summary

Compared with mixed age and younger samples, there is a paucity of clinical research specific to OABD. To date, the treatment literature in OABD is limited by small sample sizes, cohorts of mixed-age populations, and non-randomized and uncontrolled study designs. Consequently, making evidence-based treatment decisions often requires extrapolating data from studies of younger adults with BD. Fortunately, international collaborative efforts have recently been established that will include, for the first time, much larger sample sizes to better characterize the natural history, clinical course, comorbidities, and effective therapies for OABD.

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References an Recommended Reading

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

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Authors and Affiliations

  1. Division of Geriatric Psychiatry, McLean Hospital, 115 Mill Street, Mailstop 234, Belmont, MA, 02478, USA

    Regan E. Patrick PhD, Hannah L. Heintz BA, Miranda D. Skurla BS & Brent P. Forester MD, MSc

  2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Regan E. Patrick PhD & Brent P. Forester MD, MSc

  3. Department of Neuropsychology, McLean Hospital, Belmont, MA, USA

    Regan E. Patrick PhD

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Regan E. Patrick declares that he has no conflict of interest. Hannah L. Heintz declares that she has no conflict of interest. Miranda D. Skurla declares that she has no conflict of interest. Brent P. Forester declares that he has no conflict of interest.

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Patrick, R.E., Heintz, H.L., Skurla, M.D. et al. A Comprehensive Review of the Evaluation, Diagnosis, and Treatment of Older Adult Bipolar Disorder. Curr Treat Options Psych 7, 508–530 (2020). https://doi.org/10.1007/s40501-020-00232-w

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