# Bringing Attention to a Forgotten Age Group: A Discussion on Late-Onset Bipolar Disorder

## TL;DR

This paper discusses the challenges of diagnosing late-onset bipolar disorder in older adults and presents a case study to highlight its unique presentation and management.

## Contribution

The paper contributes a case study that emphasizes the need for more research and guidelines for late-onset bipolar disorder in older adults.

## Key findings

- Late-onset bipolar disorder in older adults can present with symptoms like mania and paranoia.
- The case demonstrates successful management with lamotrigine and olanzapine.
- There is a lack of data and guidelines for diagnosing and treating this condition in older adults.

## Abstract

Affecting millions worldwide, bipolar disorder is a chronic condition most commonly diagnosed before the age of 50. However, diagnosing bipolar disorder beyond this age bracket presents unique challenges and is referred to as late-onset bipolar disorder. Due to the limited availability of data, this diagnosis remains complex.

Although several efforts have been made to understand the impact of age of onset and neurologic etiologies on the condition, extensive research on this subject is unavailable, which will definitely facilitate enhancing services to this group.

We present the case of a 75-year-old male with a past psychiatric history of late-onset bipolar disorder, anxiety, depression, and a historical diagnosis of obsessive-compulsive personality disorder. He was first diagnosed with bipolar I disorder in his 60s following a manic episode by his primary care physician. His condition was subsequently managed with lamotrigine 100 mg daily and olanzapine 2.5 mg daily. No prior hospitalizations for mania or any other psychiatric etiology were noted.

During this admission to the hospital, the patient presented with symptoms of mania and paranoia and was difficult to redirect. He exhibited signs of distractibility, tangentiality, pressured speech with increased pace, flight of ideas, and reduced need for sleep.

This case helps highlight the variability in presentation of bipolar disorder in older adults, unexplained by other organic causes, and its successful management. It also instigates a discussion about limited data and guidelines in this age group.