Bipolar Disorder in Later Life
Publication Year: 2007
Published by: The Johns Hopkins University Press
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Bipolar disorder is a serious chronic mental illness that is associated with substantial impairments in quality of life and functional outcomes, high rates of suicide, and high financial costs. Although the persistent and chronic nature of bipolar disorder is well known, the unique clinical presentation, health outcomes, and optimal treatments for older adults with bipolar disorder are far less understood...
List of Contributors
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List of Abbreviations
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PART I: EPIDEMIOLOGY AND ASSESSMENT
1 Epidemiology of Bipolar Disorder in Later Life
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Bipolar disorder is a serious and chronic mental illness. It is associated with substantial functional and quality-of-life impairments, increased rates of suicide, and high financial costs. Type I bipolar disorder occurs in 0.4%–1.6% of the U.S. population, affecting between 1 and 3.5 million individuals (Bourdon et al. 1992; Regier et al. 1984). Type II bipolar disorder, characterized by hypomanic episodes...
2 Mood Rating Scales and the Psychopathology of Mania in Old Age: Selected Applications and Findings
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Clinical research on bipolar disorder in later life has been relatively limited. However, increasing professional and lay recognition of the clinical challenges and public health importance of bipolar disorder in elderly persons has markedly raised the priority and resources assigned to such research, including controlled treatment trials. Appropriate psychometrically validated assessment...
3 Comprehensive Assessment of Persons with Bipolar Disorder in Long-Term Care Settings: The Potential of the interRAI Family of Instruments
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Following the trend to de-institutionalize patients in psychiatric hospitals, which began in the 1950s and continued through the mid-1970s, nursing homes (NHs) began to take over the care of increasing numbers of persons with severe and persistent mental illness. The number of elderly people living in psychiatric hospitals in the United States decreased 40%, while the number of individuals with mental illness...
PART II: TREATMENT
4 Late-Onset Bipolar Disorder and Secondary Mania
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Mood disorders, including bipolar disorder, are underdiagnosed in elderly persons (Charney et al. 2003). While some older persons with mania may have a history of early-onset bipolar disorder, others may have developed mania for the first time in late life. Those with late-onset mania may have idiopathic late-onset bipolar disorder or “secondary mania,” that is, mania resulting from an underlying medical condition...
5 Biological Treatments of Bipolar Disorder in Later Life
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The pharmacological treatment of bipolar disorder in older adults has been a neglected area of clinical and research focus. Current treatment guidelines for bipolar disorder do not provide specific recommendations for adapting treatment to older adults (Snowdon 2000). The recent consensus statement of the Depression and Bipolar Support Alliance...
6 Psychosocial Interventions for Older Adults with Bipolar Disorder: Navigating Terra Incognita
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What is it like to grow old with bipolar disorder? What new challenges present themselves to individuals growing old with this illness? What new coping skills are required? What types of psychosocial intervention are effective in improving outcomes for older individuals with bipolar disorder?...
7 Adherence to Treatment: A Life-Course Perspective
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A cornerstone of medical treatment for bipolar disorder is mood-stabilizing medication. Mood stabilizers have been defined as medications that decrease the duration, frequency, or severity of at least one phase of bipolar disorder without adversely affecting other phases (Calabrese et al. 2002). Regular use of mood-stabilizing medications, in conjunction with psychosocial interventions, allows many individuals with bipolar disorder...
PART III: COMPLEXITY AND COMORBIDITY
8 Substance Abuse among Older Adults with Bipolar Disorder
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Only recently have efforts been made to increase our understanding of the impact of aging on bipolar disorder (Chen et al. 1998; Depp and Jeste 2004; Young 1997). This development comes at an appropriate time, as the aging of the “baby boom” cohort is likely to increase the need and demand for mental health care for older adults generally (Day 1996)...
9 Medical Comorbidity in Late-Life Bipolar Disorder
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Mr. P. is an 80-year-old man with a 50-year history of bipolar disorder. The disorder was diagnosed in 1955, when, at age 29, he had his first manic episode. During his younger adulthood he had several manic and depressive episodes, questionable adherence to his prescribed medication, and alcohol abuse. In his fifties, he stopped using alcohol and was maintained on lithium at 1,200 mg/ day, with good results...
10 Cultural Issues in the Diagnosis and Treatment of Bipolar Disorder
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Culture has been defined as “a common heritage or set of beliefs, norms, and values” (U.S. Department of Health and Human Services 1999). Such a definition gives the impression that culture is something that is static and that resides in the individual, however common the particular values may be. Kleinman (1996) defined culture as follows...
PART IV: SPECIALIZED CARE DELIVERY AND RESEARCH
11 Specialized Care Delivery for the Older Adult: Quality of Care
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Despite the existence of clinical practice guidelines, the quality of care and subsequent outcomes for older persons with bipolar disorder remain suboptimal (Bauer et al. 2002; Kilbourne 2005a). Moreover, patients with bipolar disorder are more likely to have medical comorbidities than the general patient population (Kilbourne et al. 2004a), and subsequent medical and preventive care may be lacking as well...
12 Evidence-Based Medicine and the Treatment of Older Adults with Bipolar Disorder
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Evidence-based medicine (EBM) is the provision of health care that systematically integrates the best available research evidence with clinical expertise and a patient’s unique values, preferences, and circumstances (Straus et al. 2005). In this chapter, we discuss the importance of EBM in the treatment of older adults with bipolar disorder...
13 Legal and Ethical Issues in Bipolar Disorder Research Involving Older Adults
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Research with participants who have been diagnosed with bipolar disorder entails significant legal and ethical issues. Many of these issues relate to the informed consent process, such as the capacity of the prospective research participant to provide or withhold his or her consent to participation, the ability of the individual to understand the information provided by the research team, the designation of a surrogate...
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Page Count: 280
Illustrations: 9 line illustrations
Publication Year: 2007