Bipolar and Related Disorders

Manic and hypomanic symptoms in late life are, more likely than not, recurrent episodes of bipolar disorder which began early in life. A manic or hypomanic episode which occurs for the first time in late life is often associated with, or due to, systemic medical comorbidity and can be considered secondary mania/hypomania. By similar reasoning, a patient with a pre-existing unipolar depressive disorder which first occurred earlier in life, and who subsequently develops a first manic episode in late life, may be re-diagnosed as bipolar I disorder. One study of a cohort with recurrent unipolar depressive disorders found that at least 1% per year converted to bipolar disorder with a manic episode over the course of their lifetimes, even beyond age 70 (Angst et al., J Affect Disord 84:149–57, 2005). A detailed history of mood episodes for the geriatric patient and a thorough medical evaluation is therefore essential. This chapter provides an overview of the diagnosis and treatment of bipolar disorder and related disorders in late life. In the aging patient, mania or hypomania can emerge in the context of cognitive deficits, communication difficulties, systemic medical comorbidities, and medication effects, all of which can confound assessment and accurate diagnosis. Conditions which can present with mania or hypomania include behavioral and psychological symptoms of dementia (BPSD) and delirium with symptoms such as apathy, distractibility, labile mood, anxiety, and irritability (Cassel and Fulmer, JAMA 327:919–920, 2022). The search for causes of secondary manic or hypomanic symptoms which appear in late life can help minimize unnecessary or inappropriate treatment.