ABSTRACT
Bipolar disorder typically begins in late adolescence or early adulthood; however, de novo presentation of symptoms that meet DSM-IV criteria for bipolar disorders is both challenging to diagnose and to treat. Onset of symptoms in late life is often considered secondary to vascular disorders, traumatic brain injury or occasionally an adverse drug reaction. Although rare, concluding that onset of bipolar disorder at an older age is secondary to vascular disorder etc. is risky and likely erroneous. On the other hand, longitudinal studies of the phenomenology of bipolar disorder suggest some differences in phenomenology, course, comorbidities, and outcome and importantly the need for health care services.
