Faire FACE© au trouble bipolaire chez la personne âgée : défis cliniques

Bipolar disorder (BPD) deserves special attention in a psychogeriatric context given the clinical complexity, suicidal risks and functional impairment implied. Bipolar disorder in the elderly (over age 60) nevertheless remains understudied. Through a case study presented in the context of the multisite European program FACE©-Bipolar (for: facilitation of adjustments of cognitions and emotions), the clinical challenges of BPD in elderly patients are analyzed relative to the current literature basis. Geriatric BPD is not well documented as yet, its clinical prevalence estimates ranging from 5 to 19% of affective disorders. Given that the elderly tend to confront multiple medico-social difficulties, clinical challenges for efficiently identifying and taking care of BPD in older patients mainly consist of recognizing bipolar symptoms within a geriatric context, establishing differential diagnoses with, for instance, agitated depression or dementia, dealing with probable comorbid neurosomatic impairments as well as determining the primary or secondary nature of the bipolar manifestations, especially mania, relative to patients' personal and family psychosocial history. Comprehensive understanding of bipolar disorder in the elderly requires a multidisciplinary approach to integrate all relevant bio-psycho-social factors. Implementing multimodal therapeutic protocols such as the FACE© program appears to contribute to elderly bipolar patients' clinical stabilisation, with systematic psycho- educational follow-up allowing elderly bipolar patients and their environment to develop adequate strategies to face the challenges of lifelong continuing management of bipolar disorder.