Late-onset bipolar disorder: a case for careful appraisal

Bipolar disorder is a chronic mental illness with a profound personal and public health costs attached to it. The majority of patients suffering from bipolar disorder have an onset prior to the fifth decade of their lives. However, a significant number of patients have onset of illness after age 50, commonly referred to as late-onset bipolar disorder. Age of onset can have a significant impact on the nature and course of bipolar illness. We present an interesting case of late-onset bipolar disorder while evaluating secondary mania. The patient was a 76-year-old African American woman who presented with religious and sexual preoccupations, reduced requirement of sleep, and auditory hallucinations. Magnetic resonance imaging scans of the brain revealed diffuse atrophy and two localized lesions on T2 weighted images. Diagnosing late-onset bipolar disorder requires a meticulous assessment for all the potential secondary causes. This might be challenging given the number of confounding agents and the attached cost. Nevertheless, thorough work-up to rule out secondary causes remains the centerpiece of correctly diagnosing and effectively treating late-onset bipolar disorder.