Annemiek Dols1, Lars Vedel Kessing2, Sergio A Strejilevich3, Soham Rej4,5, Shang-Ying Tsai6,7, Ariel G Gildengers8, Osvaldo P Almeida9, Kenneth I Shulman10, Martha Sajatovic11. 1. Old Age Psychiatry, GGZinGeest, VU Medical Center, Amsterdam, The Netherlands. a.dols@ggzingeest.nl. 2. Psychiatric Center Copenhagen, Faculty of Health and Medical Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 3. Bipolar Disorder Program, Gerontopsychiatry Department, INECO, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina. 4. Division of Geriatric Psychiatry, University of Toronto, Toronto, Canada. 5. Geri-PARTy Research Group, Jewish General Hospital, McGill University, Montreal, Canada. 6. Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan. 7. Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 8. Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 9. School of Psychiatry and Clinical Neurosciences & Centre for Medical Research, The University of Western Australia, Perth, Australia. 10. Geriatric Psychiatry, Faculty of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. 11. Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
Abstract
OBJECTIVE: Older adults with bipolar disorder (OABD) are a growing segment of patients with bipolar disorder (BD) for which specific guidelines are warranted. Although, OABD are frequently excluded from randomized controlled trials due to their age or somatic comorbidity, more treatment data from a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world. METHODS: The International Society of Bipolar Disorders OABD task force compiled and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards). RESULTS: There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD. General principles for treating OABD with medication are recommended to be similar to those for younger adults, with special caution for side effects due to somatic comorbidity and concomitant medications. Therapeutic lithium serum levels are suggested to be lower but recommendations are very general and mostly not informed by specific research evidence. CONCLUSIONS: There is a lack of emphasis of OABD-specific issues in existing guidelines. Given the substantial clinical heterogeneity in BD across the life span, along with the rapidly expanding population of older individuals worldwide, and limited mental health workforce with geriatric expertise, it is critical that additional effort and resources be devoted to studying treatment interventions specific to OABD and that treatment guidelines reflect research findings.
OBJECTIVE: Older adults with bipolar disorder (OABD) are a growing segment of patients with bipolar disorder (BD) for which specific guidelines are warranted. Although, OABD are frequently excluded from randomized controlled trials due to their age or somatic comorbidity, more treatment data from a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world. METHODS: The International Society of Bipolar Disorders OABD task force compiled and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards). RESULTS: There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD. General principles for treating OABD with medication are recommended to be similar to those for younger adults, with special caution for side effects due to somatic comorbidity and concomitant medications. Therapeutic lithium serum levels are suggested to be lower but recommendations are very general and mostly not informed by specific research evidence. CONCLUSIONS: There is a lack of emphasis of OABD-specific issues in existing guidelines. Given the substantial clinical heterogeneity in BD across the life span, along with the rapidly expanding population of older individuals worldwide, and limited mental health workforce with geriatric expertise, it is critical that additional effort and resources be devoted to studying treatment interventions specific to OABD and that treatment guidelines reflect research findings.
Authors: Patricia Marino; Herbert C Schulberg; Ariel G Gildengers; Benoit H Mulsant; Martha Sajatovic; Laszlo Gyulai; Rayan K Aljurdi; Laurie Davan Evans; Samprit Banerjee; Ruben C Gur; Robert C Young Journal: Int J Geriatr Psychiatry Date: 2017-05-22 Impact factor: 3.485
Authors: Alberto Bocchetta; Francesca Cabras; Martina Pinna; Antonio Poddighe; Claudia Sardu; Raffaella Ardau; Caterina Chillotti; Maria Del Zompo Journal: Int J Bipolar Disord Date: 2017-07-09
Authors: Willem A Nolen; Rasmus W Licht; Allan H Young; Gin S Malhi; Mauricio Tohen; Eduard Vieta; Ralph W Kupka; Carlos Zarate; René E Nielsen; Ross J Baldessarini; Emanuel Severus Journal: Bipolar Disord Date: 2019-06-20 Impact factor: 6.744