In this course, knowledge regarding literature updates, as well as guidelines for treatment of the aging patient with bipolar disorder are shared. This course highlights several challenging and complicated cases of geriatric bipolar disorder treated in an interdisciplinary outpatient clinic, sharing lessons learned from those clinical encounters with the assistance of a clinical psychiatric pharmacist. The management of traditional mood stabilizers and associated symptoms of subtle toxicity related in the context of medical co-morbidity and aging is also reviewed, along with the difficulties of managing a patient with newly diagnosed Parkinson's disease. Lastly, a case will be presented on neurocognitive decline concerning for a major neurocognitive disorder in a patient with longstanding bipolar disorder. 

**This content was captured at the 2019 APA Annual Meeting and may reference information from various sources and terminology from previous editions of the DSM.

Course References

• Abdul-Hamid WK et al. Comparison of how old age psychiatry and general adult psychiatry services meet the needs of elderly people with functional mental illness: cross-sectional survey. Br J Psychiatry. 2015;207:440-3.
• Sajatovic M, et al. International Society for Bipolar Disorders task force for older adults with bipolar disorder: A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force. Bipolar Disord. 2015 Nov;17(7):689-704.
• Forester BP, Ajilore O, Spino C, Lehmann SW. Clinical characteristics of patients with late life bipolar disorder in the community: Data from the NNDC registry. Am J Geriatr Psychiatry. 2015 Sep;23(9):977-84.
• Young R, et al. GERI-BD: A randomized double-blind controlled trial of lithium and divalproex in the treatment of mania in older patients with bipolar disorder. AJP in Advance. 2017 Aug 4:1-8.

Learning Objectives

• Evaluate the pharmacologic management strategies of bipolar disorder in patients with co-morbid Parkinson's disease
• Discuss the complications of bipolar symptoms associated with the pharmacologic agents used to treat Parkinson's disease
• Review the use of mood stabilizers in a geriatric patient with bipolar disorder and an emerging major neurocognitive disorder
• Explore and discuss cases of subtle toxicity from mood stabilizers in the geriatric population

Target Audience

Psychiatrists, Residents/Fellows

Estimated Time to Complete

Estimated Duration: 45 minutes
Begin Date: March 1, 2020
End Date: March 1, 2023

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The APA designates this enduring CME activity for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Program Presenters

• Erica C. Garcia-Pittman, MD, FAPA, Associate Professor, Dell Medical School Department of Psychiatry. Reports no financial relationships with commercial interests.
• Tawny L. Smith, PharmD, BCPP, Psychiatric Pharmacist, Assistant Professor of Psychiatry, Dell Medical School. Reports no financial relationships with commerical interests.
• Anh-Thu Tran, MD, Public Psychiatry, Austin Travis County Integral Care. Reports no financial relationships with commercial interests.
• Victor M. Gonzalez, Jr., MD, Fellowship, Geriatric Psychiatry, University of Texas Health Science Center at San Antonio. Disclosures: Other - Boehringer Ingelheim Pharmaceuticals, Inc. (serving as sub-investigator for two phase II trials)
• Alexandra Harrison, MD, Locum tenens, Austin, TX. Reports no financial relationships with commercial interests.

Program Planners

• Tristan Gorrindo, M.D., Director of Education, American Psychiatric Association. Reports no financial relationships with commercial interests.

Accessibility for Participants with Disabilities

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. If you have trouble accessing any of APA’s online resources, please contact us at 202-559-3900 for assistance.

Technical Requirements

This internet-based CME activity is best experienced using any of the following:

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
• Internet Explorer 11+

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
• Internet Connection: 1 Mbps or higher

Minimum Requirements:

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance