The late-onset bipolar disease: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S335-S335
Author(s):  
A. Lopes ◽  
P. Sales
Keyword(s):  
Bipolar Disorder ◽  
Late Onset ◽  
Neurological Diseases ◽  
Balance Sheet ◽  
Manic Episode ◽  
The Elderly ◽  
Elderly Subjects ◽  
Psychomotor Agitation ◽  
The Usa ◽  
Competing Interest

The prevalence of bipolar disorder after 65 years is 0.1 to 0.4%. Mania represents 4.6% to 18.5% of all psychiatric admissions in geriatrics in the USA. It has some specificity in terms of clinical presentation, evolution, prognosis and treatment.We report the case of a patient who presented a first manic episode after 65 years. E.H, AP, 67 years old, single, without personal and familial psychiatric history, addressed to psychiatric emergencies for psychomotor agitation and euphoric mood. He presented two months ago a manic access with almost total insomnia, euphoria, psychomotor agitation and delusions of grandeur. The balance sheet reveals no incorrections (blood count, thyroid balance, serology: TPHA, VDRL, hepatitis B and C, HIV). The cerebral CT was normal. The patient has been received a quetiapine 200 mg/day, olanxapine 10 mg/day and valproate 1000 mg/day. The evolution after three weeks was favorable.The late-onset bipolar disorder is characterized by: a less intense euphoria, replaced by anger and irritability, a more elements of persecution, disinhibiting and impulsivity. Respecting to that, this case is an exception. The most common confounding symptoms and behavioral disorders. A higher frequency of neurological diseases is noted in elderly subjects with a bipolar disorder and, so, a neuropsychiatric rigorous evaluation is fundamental to exclude the possibility of an organic pathology for the manic access. The prescription of psychotropic drugs in the elderly must be under monitoring.Disclosure of interest The authors have not supplied their declaration of competing interest.

P.0371 Bipolar disorder in the elderly: differences in long-term morbidity between patients with early and late onset

2021 ◽  
Vol 53 ◽  
pp. S270-S271
Author(s):  
C. Elefante ◽  
G.E. Brancati ◽  
T. Gemmellaro ◽  
A. Petrucci ◽  
L. Lattanzi ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Late Onset ◽  
The Elderly

Manic syndromes in old age

2013 ◽  
Author(s):  
Akshya Vasudev
Keyword(s):  
Bipolar Disorder ◽  
Clinical Presentation ◽  
Age Of Onset ◽  
Late Onset ◽  
Epidemiological Data ◽  
The Elderly ◽  
Published Data ◽  
Management Options ◽  
Pharmacological Management ◽  
Heterogenous Group

Manic syndromes in the elderly are different from those seen in the younger bipolar population. They are a heterogenous group but can probably be divided into two main groups based on age of onset of the illness: late onset bipolar disorder (LOB) and early onset bipolar disorder (EOB). This chapter elaborates on differences in these two groups based on epidemiological data findings, clinical presentation, aetiopathogenesis and management. Latest concepts with regards to the vascular mania hypothesis, neuroimaging findings, cognitive impairment in bipolar disorder are also dealt with. A critical review of pharmacological management options is also provided with reference to recently published data on mood stabilisers, antipsychotic and antidepressant usage for this age group.

Late-onset bipolar disorder: What else?

2016 ◽  
Vol 33 (S1) ◽  
pp. S121-S121
Author(s):  
C.P. Ferreira ◽  
S. Alves ◽  
C. Oliveira ◽  
M.J. Avelino
Keyword(s):  
Elderly Patient ◽  
Bipolar Disorder ◽  
Treatment Guidelines ◽  
Late Onset ◽  
Mood Stabilizer ◽  
The Elderly ◽  
First Episode ◽  
Therapeutic Implications ◽  
Psychiatric Conditions ◽  
New Onset

IntroductionGeriatric-onset of a first-episode mania is a rare psychiatric condition, which may be caused by a heterogeneous group of non-psychiatric conditions. To confirm late-onset bipolar disorder (LOBD) diagnosis, secondary-mania causes should be ruled out.ObjectivesTo provide a comprehensive review reporting prevalence, features, differential diagnosis, comorbidity and treatment of LOBD.MethodsThe literature was systematically reviewed by online searching using PubMed®. The authors selected review papers with the words “Late-onset mania” and/or “Late-onset bipolar” in the title and/or abstract published in the last 10 years.Results and discussionWith population ageing, LOBD is becoming a more prevalent disorder. Clinical presentation may be atypical and confounding, making the diagnosis not always obvious. Several non-psychiatric conditions must be considered in an elderly patient presenting with new-onset mania, namely stroke, dementia, hyperthyroidism or infection causing delirium. Only then LOBD diagnosis may be done, making that an exclusion diagnosis. Comorbidities, such as hypertension or renal insufficiency are often present in the elderly and must be taken into account when choosing a mood stabilizer.ConclusionsLOBD remains a complex and relatively understudied disorder with important diagnostic and therapeutic implications. This diagnosis must be kept in mind for every elderly patient presenting with new-onset mania. Further investigations could contribute to a better understanding of LOBD etiopathogenesis and to set out better treatment guidelines.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Late-onset Bipolar Disorder: A Comparative Study

2017 ◽  
Vol 41 (S1) ◽  
pp. S113-S114
Author(s):  
C. Derbel ◽  
R. Feki ◽  
S. Ben Nasr ◽  
S. Bouhlel ◽  
B. Ben Hadj Ali
Keyword(s):  
Comparative Study ◽  
Late Onset ◽  
Demographic Data ◽  
Bipolar Disorders ◽  
The Elderly ◽  
University Hospital ◽  
Professional Activity ◽  
Competing Interest ◽  
Secondary Mania ◽  
Depressive Episodes

IntroductionBipolar disorders (BP) with late onset are underestimated by their frequency, their misleading presentations and therapeutic difficulties due to the high prevalence of somatic comorbidities.AimTo identify sociodemographic, clinical and therapeutic characteristics in subjects with a late-onset BP.Patients and methodsRetrospective and comparative study of 101 patients followed for a BP (12 patients with BP started after 50 years and 89 patients with BP started earlier) from 2009 to 2015, in the department of psychiatry of the University Hospital Farhat Hached, Sousse, Tunisia.ResultsThe mean age of subjects with late-onset TBP was 46.11 ± 12.85 years. Women were in the majority (65.3%). Ten patients had a novo mania, four patients had a late-onset mania and one patient had a secondary mania. Regarding the socio-demographic data, only the regular professional activity was more reported in the elderly (P = 0.017). Regarding clinical data, BP type 1 and secondary mania were more reported in elderly with (P = 0.050 and P = 0.000 respectively). Elderly had significantly fewer depressive episodes (P = 0.026), fewer hypomanic episodes (P = 0.000). The durations of the latest episodes and the last intervals were shorter in elderly (P = 0.045 and P = 0.000). Concerning therapeutic data, elderly had fewer hospitalizations (P = 0.045), required lower mean doses of lithium (P = 0.04) and greater mean doses of tricyclic antidepressants (P = 0.047).ConclusionIt is always necessary to look for an organic cause in manic syndrome in late-onset BP. Doses of lithium should be lower. However, doses of TAD should be higher.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatment of bipolar patients in manic phase: A comparison between asenapine and aripiprazole

2016 ◽  
Vol 33 (S1) ◽  
pp. S331-S332
Author(s):  
L. Girardi ◽  
S. Gili ◽  
E. Gambaro ◽  
E. Di Tullio ◽  
E. Gattoni ◽  
...  
Keyword(s):  
Metabolic Profile ◽  
Blood Count ◽  
Complete Blood Count ◽  
Manic Episode ◽  
Acute Effects ◽  
Psychomotor Agitation ◽  
Specific Patient ◽  
Manic Symptoms ◽  
Competing Interest ◽  
Bipolar Patients

IntroductionAgitation is the most evident symptom in an acute manic episode. It can be defined as excessive motor or verbal activity that can degenerate into aggressive behaviour. Both aripiprazole and asenapine are indicated for the treatment of agitation in patients with manic episode.AimsTo retrospectively evaluate the acute effects of drug therapy on psychomotor agitation rated with the PANSS-EC, the change in manic symptoms through the YMRS, the QoL with the SF-36v2 and the cardiometabolic effects of the new oral APS.MethodsWe administered the following tests to 13 patients with DBI at T0 (baseline), T1 (after 1 week), T2 (after 4 weeks), T3 (after 12 weeks) and T4 (after 24 weeks): PANSS-EC, YMRS, SF-36v2, CGI-BD, CGI-S, HAM-D, BPRS. We also considered weight, height, BMI, ECG and complete blood count.ResultsPatients recruitment and statistical analyses are still in progress. Our preliminary results suggest that there is not a marked difference between the two drugs. We highlighted that there has been a noticeable decrease in results at PANSS as well as at YMRS from T0 to T4 and patients showed an improvement in QoL. Only one patient treated with asenapine showed an increase in the results of HAM-D.ConclusionsResults suggest the efficacy of the two new APS but further recruitment and data collection are needed to better understand their impact on agitation and QoL, including the metabolic profile, with the aim to help clinicians to make a more accurate choice of drug for each specific patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depot aripiprazole as maintenance treatment in bipolar disorder: Report of a case

2016 ◽  
Vol 33 (S1) ◽  
pp. S332-S332
Author(s):  
C. Gómez Sánchez-Lafuente ◽  
R. Reina Gonzalez ◽  
A. De Severac Cano ◽  
I. Tilves Santiago ◽  
F. Moreno De Lara ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Maintenance Treatment ◽  
Oral Treatment ◽  
Manic Episode ◽  
Mood Stabilizers ◽  
Community Center ◽  
Psychotic Symptoms ◽  
Competing Interest ◽  
Long Acting

IntroductionRecently, depot aripiprazole was approved as a maintenance treatment for schizophrenia. However, long-acting antipsychotics has not been established efficacy in manic episode or maintenance treatment of bipolar disorder.AimsDescribe a clinical case of multiresistant bipolar disorder.MethodsThirty-nine years old male, diagnosed since 8 years ago with bipolar disorder, current episode manic with psychotic symptoms, admitted to Acute Psychiatrist Unit. It was his seventh internment. He was dysphoric, had insomnia, and showed many psychotic symptoms like grandiose delusions and delusions of reference. He thought he was a famous painter from nineteenth century.His disorder was refractory to mood stabilizers monotherapy and to many neuroleptic and, like olanzapine 30 mg/day, depot risperidone, zuclopenthixol, haloperidol, palmitate paliperidone, He was on treatment with lithium 1200 mg/day (lithemia 0.62 prior to admission) and oral aripiprazole 15 mg/day that he was not taking regularly. Poor compliance to oral treatment. No awareness of illness.Resultsduring the patient admission, we started long-acting aripiprazole 400 mg per 28–30 days. First 3 days he persisted dysphoric, hostile, and showing delusions of mind being read. From the fourth day, delusions disappeared and later he was calmer and more friendly, He was discharged 9 days later fully euthymic.For 6 months follow-up, the patient came once a month to community center for aripiprazole injection and he was taking lithium regularly. Last lithemia 0.65 mEQ/L.ConclusionLong-acting antipsychotics, like depot aripiprazole could be a useful alternative to oral medication, specially when there is no awareness of illness and there is low adherence to oral treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mental health and drug

2016 ◽  
Vol 33 (S1) ◽  
pp. S328-S328
Author(s):  
R. Alonso Díaz ◽  
E. Cortázar Alonso ◽  
H. Guillén Rodrigo
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Therapeutic Response ◽  
Manic Episode ◽  
Total Sample ◽  
Epidemiological Studies ◽  
High Prevalence ◽  
Addiction Service ◽  
Competing Interest ◽  
Provincial Center

IntroductionBipolar disorder (BD) is often associated with various comorbidities. It is substance use disorders (SUD) one of the most frequent comorbidities.The ECA study (Epidemiologic Catchment Area) observed a prevalence over the life of the 56, 1% for any TUS in the total sample of patients with bipolar disorder. In subjects with bipolar I disorder prevalence was 60.7%, and those of type II 48.1.In the OMS study conducted in America, Europe and Asia, the results confirm the high rates of disorders in patients diagnosed with bipolar disorder regardless of the country of study.CaseThis is a male, 32, who came first to the Provincial Drug Addiction Service of Huelva in 2009 for cocaine, cannabis and alcohol.In his personal history, he relates a convulsive episode at 14 years and one manic episode associated with consumption of cocaine in 2002 which began to be treated by a team of Mental Health and Provincial Center for Addictions.He entered twice in a therapeutic community in 2009 for treatment for their disorder dependence on cocaine, alcohol and cannabis.It has required admission to the Unit Hospitalization twice in 2012, with the discharge diagnosis of manic episode secondary to drug consumption.ConclusionsMost epidemiological studies in recent decades note the high prevalence of comorbidity BD + SUD.BD-SUD comorbidity is particularly complex because each disorder affects the evolution of the other and they are frequently multiple comorbidities. In addition, it implies a worse clinical and functional outcome as well as poorer therapeutic response.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Evaluation of Dependence Among Benzodiazepines in Population of Elderly Subjects Followed in Psychiatric Service in Sfax

2017 ◽  
Vol 41 (S1) ◽  
pp. S660-S660
Author(s):  
N. Messedi ◽  
I. Feki ◽  
I. Baati ◽  
R. Sellami ◽  
D. Trigui ◽  
...  
Keyword(s):  
Psychotropic Drugs ◽  
Psychiatric Service ◽  
Public Health Problem ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Elderly Subjects ◽  
Major Public Health Problem ◽  
Cross Sectional ◽  
Competing Interest ◽  
Withdrawal Signs

IntroductionBenzodiazepines (BZD) are the most consumed psychotropic drugs by the elders. This prescription can lead to the dependence which is a major public health problem particularly in this population.ObjectivesTo study the prevalence of dependence of the (BZD) in elderly subjects followed as outpatients and to identify the factors associated with it.MethodsIt was a cross-sectional study of 60 patients aged 65 years and older followed at the psychiatric consultation of the UH Hédi Chaker of Sfax; for 3 months. We used:– Questionnaire containing demographic and clinical data.– The cognitive scale of attachment to benzodiazepines (ECAB), a score ≥ 6 indicates dependence.ResultsThe average age of patients was 67.78 years, with a sex-ratio M/W = 0.46. They were smoking in 58.3% of cases. The most frequent psychiatric disorders were mood disorders (40%) followed by anxiety disorders (13.3%). The absence of diagnosis was observed in 23.3% of cases. A psychotropic drugs were associated with BZD in 86.7%. The most prescripted BZD was lorazépam (90%). Withdrawal signs were present in 90% of cases. The prevalence of BZD dependence has been estimated at 80%.BZD dependence was significantly correlated with smoking (P = 0.00), with psychotropics association (P = 0.04) and with signs of withdrawal (P = 0.001).ConclusionIt appears from our study the importance of BZD dependence in the elderly what it is a source of withdrawal difficulty. So we need make more effort to comply with recommendations regarding the prescription of these molecules.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Temporal tumor as a cause of bipolar-like disorder?

2017 ◽  
Vol 41 (S1) ◽  
pp. S471-S471
Author(s):  
S. Domingues ◽  
M. Cotter ◽  
I. Amado ◽  
R. Massano
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Symptoms ◽  
Sudden Onset ◽  
Psychomotor Agitation ◽  
Temporal Epilepsy ◽  
Co Morbidity ◽  
History Of ◽  
Competing Interest ◽  
History Of Epilepsy ◽  
Clinical Records

IntroductionThe relationship between brain tumours, temporal epilepsy and psychiatric symptoms are historically known.ObjectivesTo report a case of mania in a patient with previous diagnosis of bipolar disorder, temporal tumour and temporal epilepsy.MethodsClinical records. Research on PubMed, using “lateral temporal epilepsy” or “brain tumour” and “mania”.ResultsA 52 years old man was conducted to the emergency department by the police. He was found with psychomotor agitation at the Sanctuary of Fátima. He was apparently hyperthimic with flight of ideas. He had a history of epilepsy and temporal tumour and two previous manic episodes. It was assumed as a maniac episode.During inpatient evaluation, patient had memory for the occurrence. He described a sudden onset on the day before, after drinking wine. He described delirant atmosphere, persecutory and mystic delusional beliefs “this is the third secret of Fátima being revealed”, followed by ecstasy and psychomotor agitation. Remission was obtained in one week on psychotropics. MRI documented the lesion. Electroencephalography performed one month later revealed “slow waves.”ConclusionsOrganic causes should be excluded before consider a psychiatric disorder. The hypothesis of epilepsy-related psychosis or mania and other effects of a temporal tumour should be considered in etiology. However, co morbidity with bipolar disorder cannot be excluded.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Manic syndromes in old age

2020 ◽  
pp. 637-654
Author(s):  
Lauren Mussen ◽  
Akshya Vasudev
Keyword(s):  
Bipolar Disorder ◽  
Age Of Onset ◽  
Late Onset ◽  
Epidemiological Data ◽  
The Elderly ◽  
Mood Stabilizers ◽  
Published Data ◽  
Age Group ◽  
Management Options ◽  
Pharmacological Management

Manic syndromes in the elderly are different from those seen in the younger bipolar population. They are a heterogeneous group but can probably be divided into two main groups based on age of onset of the illness: late-onset bipolar disorder (LOB) and early-onset bipolar disorder (EOB). This chapter elaborates on differences in these two groups based on epidemiological data findings, clinical presentation, aetiopathogenesis, and management. It also discusses the latest concepts with regards to the vascular mania hypothesis, neuroimaging findings, and cognitive impairment in bipolar disorder (BD). It provides a critical review of pharmacological management options with reference to recently published data on mood stabilizers, antipsychotics, and antidepressant usage for this age group.

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