[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-443003-105":59,"doc-detail-443003-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","untangling-lateonset-firstepisode-mania-a-case-series","Untangling late‑onset first‑episode mania - A case series","","Late-onset bipolar disorder presents distinctive diagnostic and treatment difficulties because manic symptoms overlap with neurocognitive disorders, age-related physiological changes, and other medical comorbidities. Four elderly patients presented with first-episode mania, with attention to clinical course, coexisting illnesses, and treatment response. Metabolic comorbidities were present in three patients, while two had a family history of psychiatric illness. Neuroimaging showed small vessel ischemic changes in two cases. All patients required inpatient care and improved with mood stabilizers and antipsychotics.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/untangling-lateonset-firstepisode-mania-a-case-series/443003/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/untangling-lateonset-firstepisode-mania-a-case-series/443003.png","ImageObject",300,407,{"name":92,"@type":93},"dabgoudw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What makes late-onset bipolar disorder difficult to diagnose and manage?","Question",{"text":113,"@type":114},"Late-onset bipolar disorder has symptom overlaps with neurocognitive disorders, medical comorbidities, and age-related physiological changes, complicating diagnosis and management.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What did the case series report about comorbidities and neuroimaging?",{"text":118,"@type":114},"Three patients had metabolic comorbidities, two had a family history of psychiatric illness, and neuroimaging revealed small vessel ischemic changes in two cases.",{"name":120,"@type":111,"acceptedAnswer":121},"How did the patients respond to treatment in the inpatient setting?",{"text":122,"@type":114},"All four patients required inpatient care and responded well to mood stabilizers and antipsychotics, with sustained improvement documented in follow-up.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},443003,1791031621,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52,"preview_page_count":4},3985747860484,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","CASE SERIES  \nUntangling late‑onset first‑episode mania: A case series  \nHarsh Khandelwal, Sanyam Tyagi, Harmanpreet Kaur1, Vishal Verma, Naresh Nebhinani, Navratan Suthar, Pratibha Gehlawat1  \nDepartment of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, 1Department of Psychiatry, Institute of Human Behavior and Allied Sciences, New Delhi, India  \nABSTRACT  \nBackground: Late-onset bipolar disorder (LOB) presents unique diagnostic and management challenges as various symptom overlaps with neurocognitive disorders, medical comorbidities, and age-related physiological changes. Cases: Wereport four elderly patients presenting with first‑episode mania, highlighting clinical trajectories, comorbidities, and treatment responses. Three patients had metabolic comorbidities, while two had family history of psychiatric illness. Neuroimaging revealed small vessel ischemic changes in two cases, suggesting a vascular contribution. All patients required inpatient care and responded well to mood stabilizers and antipsychotics.  \nConclusion: Further research is warranted to optimize management strategies for this understudied subset of bipolar disorder.  \nKey words: Elderly first episode mania, late onset bipolar, management  \nINTRODUCTION  \nLate onset bipolar disorder (LOB) presents unique set of challenges in diagnosis and management within the realm of psychiatric disorders. Classically, bipolar disorder has been associated with an early onset, typically manifesting in late adolescence or early adulthood. However, increasing recognition of bipolar disorder occurring later in life has emerged, necessitating a deeper understanding of its clinical presentations, correlates, and management.  \nLOB refers to the onset of bipolar symptoms after the age of 50, as proposed by the International Society of Bipolar  \nAddress for correspondence: Dr. Naresh Nebhinani, Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India.  \nE‑mail: [nnebhinani@gmail.com](nnebhinani@gmail.com)  \nSubmitted: 28‑Apr‑2025, Accepted: 25‑Nov‑2025,  \nRevised: 22‑Oct‑2025, Published: 18‑Dec‑2025  \n\n| Access this article online |  |\n| --- | --- |\n| Website:\u003Cbr>[https://journals.lww.com/indianjpsychiatry](https://journals.lww.com/indianjpsychiatry) | Quick Response Code |\n|  | |\n| DOI:\u003Cbr>10.4103/indianjpsychiatry_412_25 |  |\n\nDisorders (ISBD) . [1] However, no universally agreed-upon definition regarding the exact age threshold exists. LOB seldom presents as a first episode of mania in the elderly. This subtype of bipolar disorder poses a significant diagnostic difficulty, as symptoms overlap with other psychiatric conditions commonly seen in older adults, such as neurocognitive disorders. Further complications arise from medical comorbidities and age-related changes in physiology, making diagnosis and management challenging.  \nDespite the growing recognition, there remains a paucity of literature, especially from India, specifically addressing clinical characteristics, correlates, and optimal treatment of late onset mania.  \nHere we present four cases of first episode mania in old age, depicting varied presentations, clinical trajectories,  \nThis is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑NoDerivatives 4.0 License (CC BY‑NC‑ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.  \nFor reprints [contact:](contact: WKHLRPMedknow_reprints@wolterskluwer.com)[ WKHLRPMedknow_reprints@wolterskluwer.com](contact: WKHLRPMedknow_reprints@wolterskluwer.com)  \nHow to cite this article: Khandelwal H, Tyagi S, Kaur H, Verma V, Nebhinani N, Suthar N, et al. Untangling late‑onset first‑episode mania: A case series. Indian J Psychiatry 2025;67:1187‑90.  \nKhandelwal, et al.: Untangling late‑life bipolar disorder: A case series  \ncomorbidities, tre","cbCaisvOVGqLS3pp","https://ap.wps.com/l/cbCaisvOVGqLS3pp","pdf",533115,"English","# Abstract\n## Introduction\n# Case details\n## Case 1\n## Case 2","[{\"question\":\"What makes late-onset bipolar disorder difficult to diagnose and manage?\",\"answer\":\"Late-onset bipolar disorder has symptom overlaps with neurocognitive disorders, medical comorbidities, and age-related physiological changes, complicating diagnosis and management.\"},{\"question\":\"What did the case series report about comorbidities and neuroimaging?\",\"answer\":\"Three patients had metabolic comorbidities, two had a family history of psychiatric illness, and neuroimaging revealed small vessel ischemic changes in two cases.\"},{\"question\":\"How did the patients respond to treatment in the inpatient setting?\",\"answer\":\"All four patients required inpatient care and responded well to mood stabilizers and antipsychotics, with sustained improvement documented in follow-up.\"}]","Untangling late‑onset first‑episode mania - A case series | PDF",1790702525]