VIDEO: Diagnosis, treatment of late-life mood and anxiety disorders require close attention

SAN FRANCISCO — Diagnosis and treatment of mood and anxiety disorders experienced late in life require detailed medical and psychological history, according to a presenter at the American Psychiatric Association annual meeting. 

“There are two types of individuals we’re seeing when they’re older with bipolar disorder: those who have had early onset symptoms of depression and mania and those who develop symptoms for the first time later in life,” Brent Forester, MD, MSc, chair of the psychiatry department at Tufts University School of Medicine Forester said in this video regarding his course presentation. “The vast majority have onset symptoms and age with the illness.”

Forester’s course dealt with late-life mood and anxiety disorders common in older adults, which, he said, can be disabling, and may be lethal. Therefore, diagnoses require close consideration of comorbidities, medications and other substances, psychosocial stressors associated with aging and ageism as well as psychological issues such as grief and loss of purpose.

Additionally, cognitive impairment and depression share a close link in aging populations and may present so severely that an individual may appear to have progressed to dementia. On the other hand, according to Forester, Alzheimer’s disease and other causes of dementia may cause or contribute to depression and anxiety.

Forester offered scenarios that general psychiatrists are most likely to encounter: assessing depression, anxiety and mania; conducting a suicide risk assessment; selecting appropriate pharmacological, neuromodulatory and psychotherapeutic interventions; and analyzing the complex relationship between mood and cognition, particularly in those with mild or major neurocognitive disorders.

“It’s incumbent upon us as mental health professionals who care for older adults, to be able to assess and accurately diagnose bipolar disorder, distinguish mania from dementia and delirium,” Forester added. “And to really understand how best to intervene.”