Bipolar Disorder in Older Age Patients


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Brent P. Forester
388 g
235x155x14 mm

This book provides a comprehensive but practical understanding of the clinical approach to evaluating and caring for older people with bipolar disorder. Aspects of aging that impact the diagnosis, clinical course, and management of bipolar disorder are explained; in particular, attention is drawn to the implications of comorbidities and medical complexity for the psychiatric care of older individuals with the disorder. On the other hand, similarities to treatment in younger patients are also identified. The coverage includes thorough review of current research in the field. Clinical case vignettes are used throughout to highlight practical points, and each chapter includes ¿clinical pearls¿ that summarize key points for the clinician. The book closes by examining anticipated research directions and the future needs of this patient population.
Explains the aspects of aging that impact the diagnosis, clinical course, and treatment of bipolar disorder
Part I: Introduction, Overview and Epidemiology: Definition, what is late-life bipolar disorder, what is known about demographics.- Distinguishing late-onset  vs early- onset bipolar disorder.- Bipolar 1 vs bipolar 2 disorder.- Natural history and course of illness, including morbidity, use of psychiatric and medical services.- Part II: The Clinical Assessment: Differential diagnosis, including distinguishing late-life bipolar disorder from frontotemporal dementia and from disinhibition syndromes due to neurologic disease and from secondary mania due to medications.- Aspects about the clinical interview, aspects to address in obtaining relevant history from patients and families, useful psychometric scales for office use, risk assessment,  cognitive assessment.- Comorbidities: medical comorbidities, psychiatric comorbidities, including anxiety disorders and substance use disorders and their impact on clinical course.- Part III: Neurobiology of late-life bipolar disorder: findings from current research.-  Neuroimaging findings.- Neuroprogression.- Biomarker and oxidative stress, mitochondrial distress/dysfunction.- Neurocognitive research.- Part IV: Principles of management: Overview:  Acute and Maintenance treatment, Risk for suicide, Coordination with other treating physicians , Medication adherence and risk of relapse.- Pharmacotherapy: Mania.- Pharmacotherapy: Bipolar depression.- Pharmacology: rapid cycling, mixed episodes.- Pharmacotherapy: best practices for maintenance treatment.- Lithium: overview of effects on the kidney, both acute and long-term;  impact of lithium on endocrine disease (e.g. diabetes insipidus, hypercalcemia and hyperparathyroidism).- ECT: what is its role for late-life bipolar disorder.- Cognitive impairment, dementia and late-life bipolar disorder.- Psychotherapy and psychosocial interventions, family psychoeducation and support.-Treatment settings: inpatient, partial hospitalization, outpatient, models of integrated care.- Part V: Future directions: Future directions, future research, and anticipated future needs for this population of patients.

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