Mania in late life: bipolar disorder as diagnosis by exclusion
background The underlying cause of mania in later life can be an early- or late-onset bipolar disorder or it can be a mood disorder arising from a physical illness, also known as ‘asecondary mania’. Thorough diagnostic tests are needed to differentiate between the two types ofmania.
aim To discuss the epidemiology, presentation, diagnostic considerations and treatment options when a mania develops in later life.
method The literature was studied systematically with the help of PubMed, the Cochrane Library, specialist manuals, Dutch guidelines and references.
results So far, research into the incidence and prevalence of a mania in later life has been very limited. In making a differential diagnosis of this kind of mania the clinician has to consider not only the possibility of a bipolar disorder, severe depression or psychosis but also the possibility of delirium, dementia or secondary mania. According to some researchers, a mania can be caused by various neurological, systemic and pharmacological factors. Patients should be given somatic screening, including brain imaging. Lithium and antipsychotics are the agents of choice for treating a mania occurring as part of a bipolar disorder as well as for treating a secondary mania.
conclusion Epidemiologic research into late-onset mania is limited. In older patients it is important to identify – or rule out – somatic causes (secondary mania, dementia, delirium). Symptomatic treatment is more or less on the same lines as the treatment for mania in young adults. In cases of secondary mania maintenance treatment is not always necessary, but must be considered if risk factors for bipolar disorder are present.