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Untangling late-onset first-episode mania: A case series
Harsh Khandelwal1, Sanyam Tyagi1, Harmanpreet Kaur2
1Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India.
Indian Journal of Psychiatry
|January 8, 2026
Summary
Late-onset bipolar disorder presents diagnostic challenges in the elderly. This case series highlights treatment responses and comorbidities in four elderly patients with first-episode mania.
Area of Science:
- Geriatric Psychiatry
- Neuropsychiatry
- Bipolar Disorder Research
Background:
- Late-onset bipolar disorder (LOB) poses diagnostic and management difficulties.
- Symptoms can overlap with neurocognitive disorders and medical conditions in older adults.
- Age-related physiological changes complicate LOB diagnosis and treatment.
Purpose of the Study:
- To present clinical trajectories of elderly patients with first-episode mania.
- To analyze comorbidities and treatment responses in this population.
- To underscore the need for further research in LOB management.
Main Methods:
- Case series reporting on four elderly patients with first-episode mania.
- Review of clinical presentations, comorbidities, and treatment outcomes.
- Inclusion of neuroimaging findings (small vessel ischemic changes).
Main Results:
- Three patients had metabolic comorbidities; two had a family psychiatric history.
- Neuroimaging suggested a potential vascular contribution in two cases.
- All patients required inpatient care and responded to mood stabilizers and antipsychotics.
Conclusions:
- Elderly patients with first-episode mania require specialized care.
- Mood stabilizers and antipsychotics appear effective in this cohort.
- Further research is essential to refine management strategies for LOB.
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