- 期刊
周全性老年評估個案報告：64歲女性情緒激躁併失眠
Comprehensive Geriatric Assessment of an Elderly Woman with Geriatric Bipolar Disorder: A Case Report
摘要
老年雙相情緒障礙症／老年躁鬱症（geriatric bipolar disorder）在雙相情緒障礙症中約占了四分之一，隨著全球人口成長、壽命延長，高齡人口不斷攀升，可以預估的是老年病患數量更將隨之上升。高齡長者多有為數不少的共病症若再加上身體老化的影響，將使得老年躁鬱症更加不易診斷及治療。本文描述一位老年女性個案於年輕時即診斷為憂鬱症，但藥物治療效果不佳，除憂鬱症狀無法改善，甚至因自殺行為造成四肢癱瘓，直至老年時躁症發作才確診為躁鬱症。入院後，經由周全性老年評估的方式介入，以詳細評估及文獻回顧，探討老年雙極性疾患及次發性躁症之疾病表現與治療選擇，並藉由跨領域的團隊討論，找出其潛在病因、針對其藥物選擇、脊髓損傷之復健、營養提供與後續長照資源介入及預防疾病復發等方向提供處置建議，以期協助個案改善治療效果、提升生活品質並給予家屬更多喘息空間。
並列摘要
The clinical manifestations and treatment of bipolar disorder in older patients are different from those of their younger counterparts. As indicated by previous studies, up to 25 percent of all bipolar patients are older adults, and the percentage is projected to undergo further growth in light of the ever-accelerating pace of population aging worldwide. The impact of multiple medical comorbidity and aging on elderly population poses greater complexity and challenges in the diagnosis and treatment of bipolar disorder. In this article, a 64-year-old woman had been diagnosed with depression for more than ten years. Taking antidepressants in strict compliance with the prescription since the early stage of the disease appeared to be ineffective as her conditions remained fluctuating. Moreover, the patient suffered spinal cord injury and tetraplegia due to suicidal behavior. Until an episode of manic state occurred in her sixties, bipolar disorder was eventually diagnosed. The absence of significant improvement after initial treatment resulted in her admission into the psychiatric ward where a comprehensive geriatric assessment was conducted. Through interdisciplinary team assessment, we developed a personalized plan for prevention of further functional decline and suicidal behavior.