Bipolar Disorder in Older Age Patients

Susan W. Lehmann, MD Associate ProfessorJohns Hopkins University School of MedicineDepartment of Psychiatry and Behavioral SciencesBaltimore, MDUSABrent P. Forester, MD, MScChief, Division of Geriatric Psychiatry, McLean Hospital, Belmont, MAMedical Director, Behavioral Health Integration, Center for Population Health, Partners Healthcare, Boston, MAAssistant Professor of Psychiatry, Harvard Medical School, Boston, MAUSA

• Part I: Introduction, Overview and Epidemiology: Definition, what is late-life bipolar disorder, what is known about demographics.- Distinguishing late-onset  vs early- onset bipolar disorder.- Bipolar 1 vs bipolar 2 disorder.- Natural history and course of illness, including morbidity, use of psychiatric and medical services.- Part II: The Clinical Assessment: Differential diagnosis, including distinguishing late-life bipolar disorder from frontotemporal dementia and from disinhibition syndromes due to neurologic disease and from secondary mania due to medications.- Aspects about the clinical interview, aspects to address in obtaining relevant history from patients and families, useful psychometric scales for office use, risk assessment,  cognitive assessment.- Comorbidities: medical comorbidities, psychiatric comorbidities, including anxiety disorders and substance use disorders and their impact on clinical course.- Part III: Neurobiology of late-life bipolar disorder: findings from current research.-  Neuroimaging findings.- Neuroprogression.- Biomarker and oxidative stress, mitochondrial distress/dysfunction.- Neurocognitive research.- Part IV: Principles of management: Overview:  Acute and Maintenance treatment, Risk for suicide, Coordination with other treating physicians , Medication adherence and risk of relapse.- Pharmacotherapy: Mania.- Pharmacotherapy: Bipolar depression.- Pharmacology: rapid cycling, mixed episodes.- Pharmacotherapy: best practices for maintenance treatment.- Lithium: overview of effects on the kidney, both acute and long-term;  impact of lithium on endocrine disease (e.g. diabetes insipidus, hypercalcemia and hyperparathyroidism).- ECT: what is its role for late-life bipolar disorder.- Cognitive impairment, dementia and late-life bipolar disorder.- Psychotherapy and psychosocial interventions, family psychoeducation and support.-Treatment settings: inpatient, partial hospitalization, outpatient, models of integrated care.- Part V: Future directions: Future directions, future research, and anticipated future needs for this population of patients.

“This book is concise and accessible to the generalist, yet it also provides scientific insights and clinically useful advice to the specialist along with a number of interesting diversions into less-frequented subjects.” (James W. Herron, The British Journal of Psychiatry, Vol. 213 (1), July, 2018)“This is a comprehensive review of current research regarding the evaluation and management of older adults suffering from bipolar disorder. … It is intended for general psychiatrists caring for older adults with bipolar disorder. It is also relevant for all gerontologists, residents, medical students, and health care providers and policy makers involved in the creation of programs and treatment of this patient population. … Each chapter includes clinical vignettes, learning points, and clinical pearls to illustrate the principles.” (Michael Easton, Doody’s Book Reviews, June, 2017)