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2006

Bipolar DiagnosisElusive in Elderly

BY ROBERT FINN

San Francisco Bureau

RANCISCO

—A diag-nosis ofbipolar disorder can bemissed in any patient, but thisappears to be a particular prob-lem in the elderly population, Dr. Josepha A. Cheong said at the an-nual meeting ofthe American Academy ofClinical Psychiatrists. According to clinical lorepassed down through genera-tions ofpsychiatrists, bipolar dis-order is rare in the geriatric pop-ulation, because these patientsall burn out while they’re still young. Dr. Cheong, ofthe Uni-versity ofFlorida, Gainesville, re-called being taught that during her training. But it’s just not true.Studies show that bipolar dis-order accounts for 5%-19% of mood disorder presentations inthe elderly. In one study, about10% ofchronically institutional-ized elderly patients were diag-nosed with bipolar disorder, andin another study, 17% ofpeopleover the age of60 presenting toa psychiatric emergency roomwere diagnosed with bipolar dis-order, she noted, defining her role as a clinician who is report-ing on others’ research.The diagnosis can be difficult, because bipolar disorder sharessome features ofAlzheimer’s dis-ease or other types ofdementia,on the one hand, and ofunipolar depression, on the other (see box).But it’s critical to make the rightdiagnosis. Ifbipolar disorder ismisdiagnosed as dementia, themisdiagnosis can lead to ineffec-tive treatment, early nursing home placement, continued dis-ability, and an increased risk ofsui-cide. Ifbipolar disorder is misdi-agnosed as agitated depression,symptoms might worsen and an-tidepressant use could precipitaterapid cycling or a switch to mania.Some ofthe DSM-IV criteriafor mania might present differ-ently in the elderly. For example,“impaired function” can be hard

BY BRUCE JANCIN

Denver Bureau

EATTLE

— An American As-sociation ofSuicidology expertconsensus panel has developedthe first evidence-based list of warning signs for suicide—andfashioned a mnemonic designedto help get out the message.The mnemonic, which AASofficials hope to disseminatewidely as an easy aid to addictionspecialists, emergency medicinespecialists, primary care physi-cians, and the general public inidentifying individuals who are atheightened suicide risk, is thefollowing: IS PATH WARM?This mnemonic phrase is anattempt to introduce a sem- blance oforder and coherenceinto what until now have beenthe totally chaotic efforts ofamultitude oforganizations try-ing to assist the public and oth-ers who are not mental healthclinicians to spot those in needofhelp, M. David Rudd, Ph.D.,explained at the annual meeting ofthe American Association of Suicidology.To illustrate the current chaos,he described his Internet searchon Google using the key words

Therapy did not improve drug treatment.

Naltrexone FavoredOver AcamprosateIn Alcoholism Trial

Suicide Experts LinkingMnemonic to Prevention

BY TIMOTHY F.KIRN

Sacramento Bureau

IEGO

— A study that isperhaps the most important con-ducted on alcohol dependencetreatment in recent years hasfound that use ofthe opiate an-tagonist naltrexone reducesdrinking, but use ofacamprosatedoes not.The COMBINE (Effect of Combined Pharmacotherapiesand Behavioral Interventions)study also suggests that medicalmanagement ofan alcohol-de-pendent patient, with a physicianproviding a prescription for nal-trexone and basic informationand advice, is as effective as cog-nitive-behavioral therapy.“We feel this is important, as itmay broaden the options for treatment for those not current-ly being treated,” Dr. RaymondF. Anton said in a presentation of the study results at the annualconference ofthe American So-ciety ofAddiction Medicine,which coincided with publica-tion ofthe results (JAMA2006;295:2003-17).The trial enrolled 1,383 alco-hol-dependent subjects and ran-domly assigned them to one of eight groups that could includeone or both ofthe drugs, or placebo, with or without whatthe investigators termed a “cog-nitive-behavioral intervention.”One group received the cogni-

A N D Y

A T I S T A

Bipolar disorder can mimic dementia or depression in the elderly,leading to ineffective treatment measures, Dr. Josepha Cheong said.

Visionary Art

Martin Cohen’s artisticconstancy has helped himweather mental illness.

PAGE 18

Kick the Habit

FDA-approved varenicline isspecifically designed to treat nicotine dependence.

PAGE 8

MolestationMessage

Billboard and helpline maybreak the cycle ofabuse.

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