Evidence-based pharmacological treatment of geriatric bipolar disorder.

Elderly individuals who have bipolar (BP) disorder present a particular challenge to clinicians, health care services, and caregivers. They are a complex and heterogeneous group of patients who frequently have comorbidities and poor outcomes, including a high mortality rate. BP elders represent 5% to 19% of patients presenting for acute treatment at geriatric psychiatry services [1,2]. They use health services heavily [3,4]. The psychopathology associated with their illness episodes (ie, mania, mixed mania, hypomania, and depression) can be severe; their signs and symptoms resemble those in younger patients [5]. Elderly BP patients who are treated for manic and mixed episodes often have incomplete response [6,7], further episodes [8–10], and high mortality rate [8,9]. Beyond recognition and careful diagnostic assessment, pharmacotherapy is the cornerstone of their management. This article addresses the current evidence regarding drug treatment of BP disorder in old age. In particular: