Bipolar disorder is different in the elderly, and today we look at the medical causes to watch out for.

Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsom, a psych NPn-p, and a dedicated reader of every issue.

This year, we did something new at the Carlat Report.

We tallied up the clicks in the online journals, broke down the paywall, and made the top 15 articles free online.

To read them, check the link in the show notes or Google Top 15 Carlet Psychiatry

Articles of 2003.

The list inspired us to turn the greatest hits into podcasts with updates from the latest research.

Today is number six.

Mania in Older Adults by Julia Cromwell from the Gero Psychiatry Report.

Why start with number six?

Because number five is a closely related piece on mood stabilizers in older adults,

which we'll cover next week.

Let's start with a case.

Alice is an 81-year-old woman who has no history of psychiatric problems, but she's brought

to your office by her children who say she's had a personality change.

Alice is euphoric, hyper, talkative, and she tells you through many tangents about a talk show host

who communicates with her late at night. All signs point to a first episode of mania in Alice,

but mania usually starts in the teenage years. Why is it coming on now in an 81-year-old woman?

Bipolar disorder typically starts around age 15 to 25.

So when you see it start in later life, especially in someone with no history of mood problems,

...