New-Onset Bipolar Disorder in Late Life: A Case of Mistaken Identity

Among individuals with late-onset bipolar II disorder, atypical features, including "mood reactivity," increased appetite or weight gain, hypersomnia, leaden paralysis, and/or a long-standing pattern of extreme sensitivity to perceived interpersonal rejection, are less common than among pe...

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Bibliographic Details
Published in:The American journal of psychiatry 2006-02, Vol.163 (2), p.198-203
Main Author: Arciniegas, David B.
Format: Article
Language:English
Subjects:
Adult and adolescent clinical studies
Affective Symptoms - diagnosis
Affective Symptoms - drug therapy
Affective Symptoms - psychology
Age
Age Factors
Age of Onset
Atrophy
Behavior
Biological and medical sciences
Bipolar disorder
Bipolar Disorder - diagnosis
Bipolar Disorder - drug therapy
Bipolar Disorder - psychology
Bipolar disorders
Brain - pathology
Dementia
Dementia - diagnosis
Dementia - drug therapy
Dementia - psychology
Diagnosis, Differential
Humans
Lithium Carbonate - therapeutic use
Magnetic Resonance Imaging
Male
Medical History Taking
Medical sciences
Middle Aged
Mood disorders
Neurologic Examination
Patients
Psychiatric Status Rating Scales
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Serotonin Uptake Inhibitors - therapeutic use
Sertraline - therapeutic use
Severity of Illness Index
Treatment Outcome
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Description
Summary:Among individuals with late-onset bipolar II disorder, atypical features, including "mood reactivity," increased appetite or weight gain, hypersomnia, leaden paralysis, and/or a long-standing pattern of extreme sensitivity to perceived interpersonal rejection, are less common than among persons with earlier-onset forms of this condition (3). In a critical review of the literature on bipolar disorder in older adults, Depp and Jeste (2) found only weak or inconsistent evidence of a reduced frequency of a family history of bipolar disorder, an increased frequency of mixed episodes, and a less robust response to standard treatments among older persons with this condition. Irrespective of his other neuropsychiatric symptoms and signs, this patient's clinical presentation is not consistent with late-onset bipolar disorder because a distinct period of abnormally and persistently altered mood-the cardinal feature of this condition-was absent.
ISSN:0002-953X
1535-7228
DOI:10.1176/appi.ajp.163.2.198