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Osvaldo P. Almeida Professor of Geriatric Psychiatry
Bipolar Disorder in Later Life:
Management Guidance
Are older adults with BD different from their younger peers?
General principles of management
Pharmacological management:
⎯ Mania
⎯ Depression
⎯ Maintenance
Conclusions
Bipolar in Later Life
Are older adults with BD different from their younger peers?
Bipolar in Later Life
⎯ OABD: BD among people aged 60 years or over. (50?)
Almeida et al. IJGP 2018;DOI: 10.1002/gps.4957
Are older adults with BD different from their younger peers?
Bipolar in Later Life
⎯ OABD: BD among people aged 60 years or over. (50?)
Almeida et al. IJGP 2018;DOI: 10.1002/gps.4957
Are older adults with BD different from their younger peers?
Bipolar in Later Life
⎯ OABD: BD among people aged 60 years or over. (50?)
Almeida et al. IJGP 2018;DOI: 10.1002/gps.4957
Are older adults with BD different from their younger peers?
Bipolar in Later Life
⎯ OABD: BD among people aged 60 years or over. (50?)
Almeida et al. IJGP 2018;DOI: 10.1002/gps.4957
Are older adults with BD different from their younger peers?
Bipolar in Later Life
⎯ OABD: BD among people aged 60 years or over. (50?)
Almeida et al. J Affect Disord 2018;239:269-73
Are older adults with BD different from their younger peers?
Bipolar in Later Life
⎯ OABD: BD among people aged 60 years or over. (50?)
Almeida et al. J Affect Disord 2018;239:269-73
Are older adults with BD different from their younger peers?
Bipolar in Later Life
⎯ OABD: BD among people aged 60 years or over. (50?)
Are older adults with BD different from their younger peers?
Bipolar in Later Life
⎯ OABD: BD among people aged 60 years or over. (50?)
Bipolar in Later Life
Older Adults with Bipolar Disorder
Lifestyle
⎯ Physical inactivity
⎯ Smoking
⎯ Alcohol
⎯ Drugs
⎯ Obesity / diet
⎯ Health literacy
General principles of management
Bipolar in Later Life
Lifestyle
⎯ Physical inactivity
⎯ Smoking
⎯ Alcohol
⎯ Drugs
⎯ Obesity / diet
⎯ Health literacy
Social
⎯ Housing
⎯ Finances
⎯ Social support
⎯ Interpersonal
⎯ Work
Older Adults with Bipolar Disorder
General principles of management
Bipolar in Later Life
Lifestyle
⎯ Physical inactivity
⎯ Smoking
⎯ Alcohol
⎯ Drugs
⎯ Obesity / diet
⎯ Health literacy
Social
⎯ Housing
⎯ Finances
⎯ Social support
⎯ Interpersonal
⎯ Work
Health
⎯ Comorbidities
⎯ Polypharmacy
⎯ Loss of function
⎯ Cognitive
remediation
⎯ Treatment and
prevention of
symptoms
Older Adults with Bipolar Disorder
General principles of management
Bipolar in Later Life
General principles of management: pharmacology
Malhi et al. MJA 2018;208:219-25
Bipolar in Later Life
General principles of management: pharmacology
MANIA
Bipolar in Later Life
MANIA
General principles of management: pharmacology
Malhi et al. MJA 2018;208:219-25
Bipolar in Later Life
General principles of management: pharmacology
Young et al. Am J Psychiatry 2017;174:1086-93
MANIA
Bipolar in Later Life
General principles of management: pharmacology
Young et al. Am J Psychiatry 2017;174:1086-93
MANIA
Bipolar in Later Life
General principles of management: pharmacology
Young et al. Am J Psychiatry 2017;174:1086-93
MANIA
Bipolar in Later Life
General principles of management: pharmacology
Young et al. Am J Psychiatry 2017;174:1086-93
MANIA
Bipolar in Later Life
General principles of management: pharmacology
Sajatovic et al. Bip Disord 2008;10:662-71
MANIA: Quetiapine
Bipolar in Later Life
General principles of management: pharmacology
Sajatovic et al. Bip Disord 2008;10:662-71
MANIA: Quetiapine
Bipolar in Later Life
General principles of management: pharmacology
Sajatovic et al. Bip Disord 2008;10:662-71
MANIA: Quetiapine
Bipolar in Later Life
General principles of management: pharmacology
Sajatovic et al. J Clin Psychiatry 2008;68:41-46
MANIA: Aripiprazole
Bipolar in Later Life
General principles of management: pharmacology
Sajatovic et al. J Clin Psychiatry 2008;68:41-46
MANIA: Aripiprazole
Bipolar in Later Life
General principles of management: pharmacology
Sajatovic et al. IJGP 2015;30:710-9
MANIA: Asenapine
Bipolar in Later Life
General principles of management: pharmacology
Sajatovic et al. IJGP 2015;30:710-9
MANIA: Asenapine
Bipolar in Later Life
General principles of management: pharmacology
Sajatovic et al. IJGP 2015;30:710-9
MANIA: Asenapine
Bipolar in Later Life
General principles of management: pharmacology
DEPRESSION:
Malhi et al. MJA 2018;208:219-25
Bipolar in Later Life
General principles of management: pharmacology
DEPRESSION: Lurasidone
Sajatovic et al. J Clin Psychiatry 2016;77:e1324-31
Bipolar in Later Life
General principles of management: pharmacology
Sajatovic et al. J Clin Psychiatry 2016;77:e1324-31
DEPRESSION: Lurasidone
Bipolar in Later Life
General principles of management: pharmacology
Sajatovic et al. J Clin Psychiatry 2016;77:e1324-31
DEPRESSION: Lurasidone + lithium or valproate
Bipolar in Later Life
General principles of management: pharmacology
MAINTENANCE
Malhi et al. MJA 2018;208:219-25
Bipolar in Later Life
MAINTENANCE
ISBD Older Adult Task Force: Delphi Survey of 25 specialists
General principles of management: pharmacology
⎯ Identify the preferred choices for maintenance treatment of OABD
⎯ Determine the place of lithium among those choices
⎯ Provide guidelines for safe and effective treatment of lithium in
OABD
AIMS:
Shulman et al. Bipolar Disord 2018
Bipolar in Later Life
MAINTENANCE
ISBD Older Adult Task Force: Delphi Survey of 25 specialists
⎯ Begin with open ended questions
⎯ Sharper focus with each iteration
⎯ Invite comments
⎯ Summarize results and feedback to group aiming to achieve
consensus (80%)
⎯ Oversight team reviews results, formulates questions and prepares
manuscript
General principles of management: pharmacology
Shulman et al. Bipolar Disord 2018
Bipolar in Later Life
Shulman et al. Bipolar Disord 2018
MAINTENANCE
ISBD Older Adult Task Force: Delphi Survey of 25 specialists
General principles of management: pharmacology
Bipolar in Later Life
MAINTENANCE
ISBD Older Adult Task Force: Delphi Survey of 25 specialists
General principles of management: pharmacology
8% 12%
12% 68%
under 5 years
10 - 15 years
15 - 20 years
20 + years
Shulman et al. Bipolar Disord 2018
Bipolar in Later Life
MAINTENANCE
General principles of management: pharmacology
Shulman et al. Bipolar Disord 2018
Bipolar in Later Life
Thank You!
