Helios Klinik Berlin-Buch, 13125 Berlin, Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, 6020 Innsbruck, Austria.
Medicina (Kaunas). 2021 Jun 8;57(6):587. doi: 10.3390/medicina57060587.
Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called "late onset" patients (LOBD), and the elder patients with a long-standing clinical history, the so called "early onset" patients (EOBD). The aim of the present literature review is to provide more information on specific issues concerning OABD, such as epidemiology, aetiology and treatments outcomes. We conducted a Medline literature search from 1970-2021 using the MeSH terms "bipolar disorder" and "aged" or "geriatric" or "elderly". The additional literature was retrieved by examining cross references and by a hand search in textbooks. With sparse data on the treatment of OABD, current guidelines concluded that first-line treatment of OABD should be similar to that for working-age bipolar disorder, with specific attention to side effects, somatic comorbidities and specific risks of OABD. With constant monitoring and awareness of the possible toxic drug interactions, lithium is a safe drug for OABD patients, both in mania and maintenance. Lamotrigine and lurasidone could be considered in bipolar depression. Mood stabilizers, rather than second generation antipsychotics, are the treatment of choice for maintenance. If medication fails, electroconvulsive therapy is recommended for mania, mixed states and depression, and can also be offered for continuation and maintenance treatment. Preliminary results also support a role of psychotherapy and psychosocial interventions in old age BD. The recommended treatments for OABD include lithium and antiepileptics such as valproic acid and lamotrigine, and lurasidone for bipolar depression, although the evidence is still weak. Combined psychosocial and pharmacological treatments also appear to be a treatment of choice for OABD. More research is needed on the optimal pharmacological and psychosocial approaches to OABD, as well as their combination and ranking in an evidence-based therapy algorithm.
关于老年双相情感障碍（OABD）的数据很少。有两类主要的患者被分类为老年首发躁狂症患者，即所谓的“晚发型”患者（LOBD），以及有长期临床病史的老年患者，即所谓的“早发型”患者（EOBD）。本文献综述的目的是提供更多关于 OABD 特定问题的信息，例如流行病学、病因学和治疗结果。我们使用 MeSH 术语“bipolar disorder”和“aged”或“geriatric”或“elderly”，从 1970 年至 2021 年进行了 Medline 文献检索。通过检查交叉引用和教科书的手动搜索，检索了额外的文献。由于 OABD 的治疗数据稀少，当前的指南得出结论，OABD 的一线治疗应与工作年龄的双相情感障碍相似，特别注意副作用、躯体合并症和 OABD 的特定风险。由于对可能的有毒药物相互作用的持续监测和认识，锂对 OABD 患者无论是在躁狂还是维持治疗中都是一种安全的药物。拉莫三嗪和鲁拉西酮可用于双相抑郁。心境稳定剂而不是第二代抗精神病药是维持治疗的首选。如果药物治疗失败，电抽搐治疗推荐用于躁狂、混合状态和抑郁，也可用于延续和维持治疗。初步结果也支持心理治疗和心理社会干预在老年 BD 中的作用。OABD 的推荐治疗包括锂和抗癫痫药，如丙戊酸和拉莫三嗪，以及拉莫三嗪用于双相抑郁，尽管证据仍然薄弱。联合心理社会和药物治疗也似乎是 OABD 的一种治疗选择。需要更多的研究来确定 OABD 的最佳药物和心理社会方法，以及它们在基于证据的治疗算法中的组合和排序。
