3.5.4 Bipolar Affective Disorder

Bipolar Affective Disorder

Prevalence/incidence:

The prevalence of bipolar disorder in older adults is estimated to be around 1-2% (Zakaria & Wei, 2019). However, bipolar disorder can be difficult to diagnose in older adults and may be underdiagnosed.

Clinical features:

Bipolar disorder in older adults can present differently than in younger adults and may be characterized by less severe manic and depressive episodes (Zakaria & Wei, 2019). Older adults with bipolar disorder may also have more medical comorbidities and cognitive impairment.

Differential diagnosis:

Bipolar disorder in older adults can be difficult to distinguish from other medical conditions such as dementia, delirium, and stroke. It is important to conduct a thorough evaluation to rule out any underlying medical conditions that may be contributing to symptoms (Zakaria & Wei, 2019).

Aetiology:

The causes of bipolar disorder in older adults are not well understood but may involve genetic, neurobiological, and environmental factors. Older adults with bipolar disorder may also have a higher prevalence of medical comorbidities such as cardiovascular disease and diabetes (Zakaria & Wei, 2019).

Management:

Treatment for bipolar disorder in older adults may include a combination of medication and psychotherapy. Mood stabilizers such as lithium and anticonvulsants are commonly used to treat bipolar disorder in older adults. Psychotherapy, particularly cognitive-behavioural therapy (CBT), may also be helpful (Zakaria & Wei, 2019).

Prognosis:

The prognosis for bipolar disorder in older adults is generally good with appropriate treatment. However, older adults may be at increased risk for medical complications associated with medication use and may require more frequent monitoring (Zakaria & Wei, 2019).

Disorder	Prevalence/Incidence	Clinical Features	Differential Diagnosis
Depression	Up to 15% of the community	Somatic complaints such as fatigue	Other medical conditions such as dementia, delirium, Parkinson’s disease
Bipolar Affective Disorder	1-2%	Less severe manic and depressive episodes	Other medical conditions such as dementia, delirium, stroke

Disorder	Aetiology	Management	Prognosis
Depression	Multifactorial, including biological, psychological, and social factors	Combination of medication and psychotherapy, such as antidepressant medications and cognitive-behavioural therapy (CBT)	Generally good with appropriate treatment, but older adults may be at increased risk for relapse and may require longer treatment periods than younger adults
Bipolar Affective Disorder	Not well understood, may involve genetic, neurobiological, and environmental factors	Combination of medication and psychotherapy, such as mood stabilizers and cognitive-behavioural therapy (CBT)	Generally good with appropriate treatment, but older adults may be at increased risk for medical complications associated with medication use and may require more frequent monitoring.

Reference:

1. Zakaria, A. M., & Wei, Y. (2019). Bipolar disorder in the elderly. The American Journal of Geriatric Psychiatry, 27(2), 230-238.
2. Table: Prevalence/Incidence, Clinical Features, Differential Diagnosis, Aetiology, Management and Prognosis of Depression and Bipolar Affective Disorder in Late Life