After the residents got back from taking the psychiatry consult service mascot Alice (and Clive) for a walk yesterday, Dr. Michele Morais delivered an excellent review of the limited literature on late onset bipolar disorder. It’s rare to see a manic episode in someone over fifty years old and it should always trigger a systematic search for an underlying medical cause. Psychiatric consultants in the general hospital may be more likely to see these patients because of this suspicion.
However, as Dr. Morais points out, it seems to respond to standard treatment according to some authors. My bias is to suspect organic etiologies and I often find deficits in executive function which might indicate an underlying major neurocognitive disorder. In fact, that reminds me of Dr. Bill Yates’ latest post indicating that bipolar disorder raises the risk for dementia:
The episodes of mania in late onset bipolar disorder probably don’t differ much in character from those which start earlier in life in that the person may display expansiveness, grandiosity, overtalkativeness, and psychosis. They may boast of great creativity but are likely too disorganized to produce much, with the possible exception of notable artists such as composer Robert Schumann.
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