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Can Fam Physician. 1999 May;45:1229-37.

Bipolar disorder in old age.

Author information

  • 1Department of Psychiatry, University of Toronto, Ontario. ken.shulman@sunnybrook.on.ca

Abstract

OBJECTIVE:

To review the classification, clinical characteristics, and epidemiology of bipolar disorders in old age with a special focus on neurologic comorbidity, high mortality, and management.

QUALITY OF EVIDENCE:

Most available data is gleaned from retrospective chart reviews and cohort studies. Treatment recommendations are based on evidence from younger populations and a few anecdotal case reports and series involving elderly people.

MAIN MESSAGE:

While relatively rare in the community setting, mania in old age frequently leads to hospitalization. It is associated with late-onset neurologic disorders (especially cerebrovascular disease) involving the right hemisphere and orbitofrontal cortex. Prognosis is relatively poor; morbidity and mortality rates are high. Management of bipolarity includes cautious use of mood stabilizers, especially lithium and divalproex.

CONCLUSIONS:

Mania in old age should trigger a careful assessment of underlying neurologic disease, especially cerebrovascular disease. Close clinical follow up is essential.

PMID:
10349067
[PubMed - indexed for MEDLINE]
PMCID:
PMC2328575
Free PMC Article
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