Abstract

Background: Late-onset mania, typically defined as onset after the age of 60 years, is rare and frequently associated with secondary organic, neurological, or metabolic causes. Primary bipolar disorder presenting for the first time in late life poses diagnostic challenges and requires careful evaluation. Case Presentation: This report discusses a 73-year-old male with no past psychiatric or significant medical history who developed a first-episode manic presentation characterized by irritability, elevated mood, grandiosity, increased psychomotor activity, and reduced need for sleep. Extensive laboratory investigations and neuroimaging were normal. The patient was diagnosed with bipolar disorder, type I, current episode manic with psychotic symptoms (ICD-11). He responded well to low-dose atypical antipsychotics and remained stable at follow-up. Conclusion: This case emphasizes the need for systematic evaluation of late-onset manic symptoms to differentiate primary bipolar disorder from secondary causes. Awareness of such presentations supports early diagnosis and tailored geriatric psychopharmacology.

• 1.   World Health Organization. Mental health of older adults. Geneva: World Health Organization; 2023.
• 2.   Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 10th ed. Philadelphia: Wolters Kluwer; 2017.
• 3.   Gelder M, Geddes J, Andreasen N, Goodwin G, Lopez-Ibor J, editors. Oxford Textbook of Psychiatry. 3rd ed. Oxford: Oxford University Press; 2020.
• 4.   Sajatovic M, Strejilevich S, Gildengers A, Dols A, Al Jurdi RK. Bipolar disorder in older age. Lancet Psychiatry. 2015;2(11):1018–27.
• 5.   Agarwal R, Kumar S, Sharma RC, Sharma DD. First-episode mania at 73 years of age: A case report. Indian J Psychiatry. 2010;52(3):269-270.
• 6.   Benedetti A, Scarpellini P, Casamassima F, Lattanzi L, Musetti L, Cassano GB. Bipolar disorder in late life: Clinical characteristics in a sample of older adults admitted for manic episode. Clin Pract Epidemiol Ment Health. 2008;4:22.
• 7.   Dols A, Kupka RW, van Lammeren A, Beekman AT, Sajatovic M, Stek ML. The prevalence and clinical characteristics of late-life mania: A review. Bipolar Disord. 2014;16(3):273-283.
• 8.   Sajatovic M. Bipolar disorder in older adults: Epidemiology and management. Am J Geriatr Psychiatry.
• 9.   Shulman KI, Herrmann N. The nature and management of mania in old age. Psychiatr Clin North Am. 1999;22(3):649–665.
• 10.   Depp CA, Jeste DV. Bipolar disorder in older adults: A critical review. Bipolar Disord. 2004;6(5):343-367.
• 11.   Brooks JO, Hoblyn JC. Secondary mania in older adults. Am J Psychiatry. 2005;162(11):2033-2038.
• 12.   Young RC, Klerman GL. Mania in late life: Focus on age at onset. Am J Psychiatry. 1992;149(6):867-876.
• 13.   Almeida OP, Fenner S. Bipolar disorder: Similarities and differences between older and younger adults. Int Psychogeriatr. 2002;14(3):311-322.
• 14.   Tohen M, Shulman KI, Satlin A. First-episode mania in old age: Clinical and treatment characteristics. J Affect Disord. 1994;32(4):187-195.

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