Later onset bipolar?

[biogirl215]

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I know that the "typical" age for bipolar onset/dx is typically around the early to mid-twenties, but have you seen much in the way of later onset bipolar, in the late twenties or thirties (or later?).

I was reading something about a women who was dx'ed with bipolar in her thirties (having previously had no impairment of functioning), and I thought that sounded a bit unusual.

Thanks!

 

[masterofmonkeys]

why not?

Bipolar DO does have a significant environmental component, with psychosocial and possible physical stressors playing a major role. I admittedly as an MS4 do not have huge amounts of experience in it, but I have never seen a first episode of mania that wasn't precipitated by a major psychosocial/physical stressor, or seen a bipolar DO patient who was not adversely affected by psychosocial stressors (in terms of mania relapse/severity).

Earlier/more profound psychological trauma seems to correlate to earlier/more severe bipolar DO. So it would make sense that later and/or milder psychological stress may result in a later onset of mania. In older patients I would also think about pro-inflammatory state and poor nutritional/vascular support as possible exacerbating factors. really cool chinese study came out recently that I can't find right now about that.

 

[LM02]

It's not uncommon, especially in women, for the first episode (or episodes) to be a major depressive episode - with later "conversion" to bipolar disorder at the onset of the first manic episode. So actual bipolar diagnosis can occur later, even with a history of mood disorder.

Other possibilities could include:

1. A history of mood cycling that wasn't recognized (or caught) prior to later age. In this case, the diagnosis may simply have occurred later than the onset. This could certainly occur in the context of the kindling hypothesis, where the mood cycling becomes more severe over time.

2. Earlier misdiagnosis of MDD, even with a history of hypomania or mania, due to the fact that patients and clinicians often have to rely on retrospective reporting (which can be problematic). This is very common.

3. Patient variability - this patient may simply have a later onset than the average patient.

And if you're talking about bipolar II, then that's a completely different can of worms...

 

[whopper]

IT could also have been that the person did have Bipolar for years before the diagnosis, but just wasn't diagnosed until then.

Tangential, but I think I had my first real case of psychosis NOS 2 weeks ago. I was doing an HCR-20 on the guy, and he was grandiose (claimed he had millions of $$, was connected to high ranked politicians)-was described as narcissistic, condescdening & irritabile which had decreased with antipsychotic treatment but had no other symptoms on a psychotic or bipolar spectrum, despite several years of him being observed on a psyche unit.

Every other case of Psychosis NOS I've seen were someone who just came to the hospital and the diagnosis was still up in the air (drug induced psychosis, schizophrenia, schizoaffective DO) or it was a complete case of bull but no one wanted to take off the diagnosis for billing purposes.

 

[biogirl215]

IT could also have been that the person did have Bipolar for years before the diagnosis, but just wasn't diagnosed until then.

I considered that, but the person in question had finished a doctorate in clinical psychology, including a post-doc, before being dx'ed. That seemed a bit high functioning for non-dx'ed/treated bipolar, but it's within the realm of possibility.

Tangential, but I think I had my first real case of psychosis NOS 2 weeks ago. I was doing an HCR-20 on the guy, and he was grandiose (claimed he had millions of $$, was connected to high ranked politicians)-was described as narcissistic, condescdening & irritabile which had decreased with antipsychotic treatment but had no other symptoms on a psychotic or bipolar spectrum

What made you decide on psychosis NOS over delusional d/o?

 

[whopper]

What made you decide on psychosis NOS over delusional d/o?

The guy had a documented history of hostility evidenced by his tone of voice, & comments he made for years. There may have also been some truth to his delusions. E.g. while they are grandiose in nature, (claims he made millions, was in some high security jobs in Washington DC) they are not bizarre and collateral information could not rule out some of his claims.

Not quite Bipolar (not enough for mania or hypomania), not quite schizophrenia (no (+) sx of psychosis other than hostility, the delusions-unknowns if they are true or false, no SES decline,), not schizoaffective disorder....

The idea of a disorder with features of but not enough for paranoid personality disorder, delusional disorder, narcisstic PD, with IED mixed in? I'd say that's enough for a "real" diagnosis of Psychosis NOS. (edited in--the guy also is being investigated for murdering 3 people)

Almost every case I've seen of Impulse Control DO NOS & Psychosis NOS were not real in the DSM sense or it was a psychiatrist who did not look into the case deeper to clear things up. Alright if the patient had been in the place for a few days. Months is unexcusable.

 

[whopper]

was reading something about a women who was dx'ed with bipolar in her thirties (having previously had no impairment of functioning), and I thought that sounded a bit unusual.

It could hae been that this person's Bipolar may have been induced by an identifiable external factor.

Excessive amounts of sunlight, medications, drugs of abuse, stressors can induce mania.