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The treatment of bipolar disorder in the elderly 

The treatment of bipolar disorder in the elderly
Chapter:
The treatment of bipolar disorder in the elderly
Author(s):

Gilberto Sousa Alves

, Felipe Kenji Sudo

, and Johannes Pantel

DOI:
10.1093/med/9780198748625.003.0022
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date: 18 August 2019

Bipolar disorder (BD) is an extremely disabling condition characterized by mood switches, and cognitive and functional impairment. The current chapter discusses the updated review on pharmacological and non-pharmacological interventions targeting BD in the elderly. The risk of concurrent medical diseases (eg, metabolic syndrome) and relatively lower tolerability than young BD make the patient safety a major concern in most cases. Evidence-based guidelines, although useful for promoting rational and effective therapy, are generally lacking in elderly BD. Current recommendations for acute mania include atypical antipsychotics, careful use of lithium, and election of valproate as the gold-standard therapy. In acute BD depression, first-line agents in monotherapy may include lithium, lamotrigine, quetiapine, and quetiapine extended release (XR). Electroconvulsive therapy may be an option for severe/refractory cases. Family members or caregivers should be encouraged to support the patient, since potential ethical issues involving patrimony or profession may arise during the treatment.

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