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

• 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
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.163.2.198

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.