Diagnosis and Management of Bipolar Disorder With Comorbid Anxiety in the Elderly.

Currently, in individuals over 65 year of age, prevalence rates of bipolar disorder range from 0.1%to 0.4%. As is the case for bipolar disorder in younger individuals, bipolar disorder may be unrecognizedor underrecognized among older adults. While anxiety disorders are frequently comorbidamong younger individuals with bipolar illness, the prevalence and impact of comorbid anxiety is farless understood among geriatric individuals with bipolar disorder, in whom anxiety disorders may beunderreported. This comorbidity may have serious consequences, since in older adult populationswith depression, the presence of comorbid anxiety is associated with more severe depressive symptoms,more chronic medical illness, greater functional impairment, and lower quality of life; the sameassociations may prove to be true in older patients with bipolar disorder. As with younger individualswith bipolar disorder, effective treatment of the underlying mood disorder is critically important beforetreating comorbid symptoms. Unfortunately, few evidence-based studies are available to guidethe treating clinician in the management of these vulnerable patients, many of whom have additionalpsychiatric or medical comorbidity.