The first manic episode occurs either early in adult life or in fifth decade ( two peaks).Majority occur in early adult life. Late life mania can be more challenging for clinicians due to its heterogeneous nature (? secondary mania (due to medications/physical disorder ) /? first presentation of (late onset) bipolar/ ?depressive disorder converting to bipolar/? mania mimicking presentations of neurodegenerative conditions).
How common is late life mania?
Dols A, Kupka RW, van Lammeren A, Beekman AT and Sajatovic M & Stek ML reviewed the existing studies to address this question. Authors included 18 selected studies addressing this issue. All were cross-sectional studies, 17 were retrospective record or data base review, altogether providing information on 22, 333 patients, with a mean sample age of 70 yrs. Sample size ranged from 48 to 16,330 individuals.
The mean prevalence of late-life mania ( after 50 yrs- defined to be more inclusive) in cross-sectional studies is 6.0% (95% CI: 4.8–7.2%). This includes both early-onset and late-onset bipolar disorder . One study specifically identified late- onset mania prevalence as 1.8% . Clinical picture suggest most present with classical symptoms and in 30–75% of cases accompanied by delusions and hallucinations. Only one study reported the prevalence of mania among patients aged 50 years and over attending an outpatient psychiatric clinic (5.7%) .
The mean prevalence of late-onset mania among in patients with bipolar disorder was 44.2% (95% CI: 37.3– 51.1%).The numbers of converters from unipolar depression to bipolar disorder was 32% in one study.
Conclusions: For every 100 admissions of those above 50 years, 6 could have mania, and of this it is likely that 2-3 of them are experiencing a first manic episode. Given the complexity and impact on life, more robust research is required to understand late presentations, especially those with late onset mania.
Limitations: limited number of studies, no longitudinal studies, small sample sizes.
Summary of the article:
The prevalence of late-life mania: a review. Dols A, Kupka RW, van Lammeren A, Beekman AT, Sajatovic M, Stek ML.Bipolar Disord. 2014 Mar;16(2):113-8.