{"title":"Outpatient Management of Bipolar Disorder in Older Adults.","authors":"Brian E Donley, Erica C Garcia-Pittman","doi":"10.1007/s11920-024-01576-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Purposeof review: </strong>Old age bipolar disorder (OABD), increasingly common as the population ages, presents unique diagnostic and treatment challenges. This selective review focuses on issues especially relevant to outpatient management.</p><p><strong>Recent findings: </strong>People with OABD may have similar frequency and severity of mood episodes compared to younger adults. Depression predominates, and mixed symptoms in both depressive and manic episodes are common. Comorbidity and excess mortality are high, with a particular bidirectional association with cerebrovascular disease. Lithium may outperform valproic acid and second-generation antipsychotics in efficacy. Tolerability and long-term safety can be improved with relatively lower target drug therapeutic levels. Outpatient clinicians treating OABD should take an active role in the recognition and management of medical comorbidities. A careful history and examination might reveal subtle signs of bipolar disorder or mixed features and change treatment. A primary target for treatment is to reduce polypharmacy when appropriate. Further trials are needed to make specific and clear recommendations in OABD.</p>","PeriodicalId":11057,"journal":{"name":"Current Psychiatry Reports","volume":" ","pages":""},"PeriodicalIF":5.5000,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Psychiatry Reports","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11920-024-01576-3","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0
Abstract
Purposeof review: Old age bipolar disorder (OABD), increasingly common as the population ages, presents unique diagnostic and treatment challenges. This selective review focuses on issues especially relevant to outpatient management.
Recent findings: People with OABD may have similar frequency and severity of mood episodes compared to younger adults. Depression predominates, and mixed symptoms in both depressive and manic episodes are common. Comorbidity and excess mortality are high, with a particular bidirectional association with cerebrovascular disease. Lithium may outperform valproic acid and second-generation antipsychotics in efficacy. Tolerability and long-term safety can be improved with relatively lower target drug therapeutic levels. Outpatient clinicians treating OABD should take an active role in the recognition and management of medical comorbidities. A careful history and examination might reveal subtle signs of bipolar disorder or mixed features and change treatment. A primary target for treatment is to reduce polypharmacy when appropriate. Further trials are needed to make specific and clear recommendations in OABD.
期刊介绍:
This journal aims to review the most important, recently published research in psychiatry. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care of those affected by psychiatric disorders.
We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as anxiety, medicopsychiatric disorders, and schizophrenia and other related psychotic disorders. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.