BIPOLAR DISORDER IN LATER LIFE Martha Sajatovic, MD, and Frederic C. Blow, PhD (Eds.) Baltimore: Johns Hopkins University Press, 2007, 280 pp., $50.00 (hardcover).
Bipolar disorder is a serious mental illness that is associated with devastating consequences not only for the patient affected by the illness but also for the patient's family and social environment. With the aging population increasing in this country and other developed countries, it is essential to get a better understanding of the subject. This book allows the reader to look at all the relevant issues involved in the care of this special population: the late-life adult with bipolar disorder.
The book is divided into four parts with 13 independent chapters, giving the reader the flexibility to move from chapter to chapter, sequentially or out of order, to visit the areas of most interest. Anyone, whether a medical professional or not, who is interested in late-life bipolar disorder can find guidance and information in this book.
Chapter 1 . The epidemiological facts of late-life bipolar disorder are considered here. Also discussed are the assessment instruments used with patients suffering with bipolar disorder in long-term facilities, the prevalence and characteristics of the illness, and the need for more studies to evaluate the characteristics of this disease. Controversy exists as to whether geriatric bipolar disorder symptoms differ from those typically seen in the youthful population. The authors present compelling arguments for the existence of such differences. Other important epidemiological issues, such as gender differences, comorbidities, and barriers to care are reviewed in this chapter.
Chapter 2 . The psychopathology of oldage mania is explored in this chapter. Recognized are the need for more research and validation of the instruments used to evaluate mood disorders in the older patient.
Chapter 3 . The authors present data on cross-sectional analysis done to explore a broad range of issues affecting the elderly with bipolar disorder in long-term facilities.
They point out the need for more research to answer questions regarding specific factors that have great impact in the lives of this population. The authors suggest that crossnational and cross-sectional comparative studies of these patients might be the most relevant.
Chapter 4 . The different treatment options for late-onset bipolar disorder and secondary mania are reviewed here. The prevalence, incidence, and special characteristics of late-onset mania are explained to distinguish them from secondary mania due to medical and pharmacological disturbances. This chapter presents the reader with a synopsis of how to work up late-onset mania and different treatment options.
Chapter 5 . An in-depth review of the pharmacological treatment options for latelife bipolar disorder. This chapter extensively reviews the literature of treatments and their side effects. They express the importance of a multidisciplinary approach: "although pharmacotherapy should be considered the backbone of treatment for bipolar disorder for older adults medication should be seen as part of a comprehensive rehabilitation strategy." The chapter continues with a range of strategies available today to treat this population.
Chapter 6 . The authors describe a psychosocial intervention that in their experience has had the greater impact in the treatment of late-life bipolar disorder patients. They describe the "life goal program," a unique program geared to older adults with mental illness living in the community. They describe very vivid and interesting real-life experiences of patients who benefited from this program. The life goal program has several components and may be difficult to replicate in certain community settings with scarce resources.
Chapter 7 . This chapter deals with an important and very familiar issue for any practicing clinician: adherence to treatment. …