Assessment and Treatment of Bipolar Disorder in the Elderly

Abstract

The aetiology of late-onset bipolar disorder is heterogeneous because the disease is more likely to have a secondary (i.e. a medical disorder or medication-induced) cause in older than in younger patients. Elderly patients with bipolar disorder typically require lithium dosages that are 25 to 50% lower than those used in younger individuals. Information on the use of valproic acid (sodium valproate) in elderly patients with bipolar disorder is limited but encouraging. In contrast, there is virtually no information regarding the use of carbamazepine or other drugs in this patient group. Electroconvulsive therapy is well tolerated by older people and can be useful for these patients.

Mood Disorder due to Herpes Simplex Encephalitis with Neuroimaging Findings Limited to the Right Hemisphere and Cerebellum: Case Report

“…Valproate is replacing lithium carbonate as the mood stabilizer of choice for elderly manic patients and in patients with organic mental disorders. 4,5 Lithium has a narrower therapeutic Psychiatry Topçuoğlu et al…”

“…5 Valproate causes less cognitive impairment compared to lithium, which is an important concern in the geriatric population. 4 The patient responded quite well to valproate.…”

“…3,4 Neurologic insults such as stroke, epilepsy, neoplasms, head trauma, brain surgery and infections have been related with a manic episode. 4,5 Secondary mania is frequently diagnosed in geriatric patients with new-onset mania. 2,6,7 Relatively late onset of illness, absence of both family psychiatric history and past psychiatric history are characteristics of this syndrome.…”

Anticonvulsivantes e antipsicóticos no tratamento do transtorno bipolar

“…12 There are only two small-sized controlled studies on mania which pointed to a similar efficacy to that of haloperidol and lithium. 46 However, it has been recently investigated in naturalistic studies, [49][50] due to its theoretically similar response to CBZ and to its higher tolerability, used alone or associated on different groups of patients with bipolar disorder, pointing to efficacy in half of them. There are few data on the teratogenicity of OXC, but it passes through the placenta and is eliminated in the maternal milk.…”

"A influência do lítio no risco para a doença de Alzheimer"

“…A Eletroconvulsoterapia é eficaz e bem tolerada no idoso bipolar e deve ser uma alternativa considerada naqueles que não toleram ou não respondem ao tratamento medicamentoso, tanto para episódios de euforia quanto de depressão (Eastham et al, 1998). A estimulação magnética transcraniana pode ser útil tanto para euforia quanto para depressão mais ainda não temos estudos publicados realizados em bipolares idosos (Sajatovic et al, 2005a).…”