The authors intend to review clinical features, epidemiology and management of bipolar disorder in elderly patients, and discuss the possibility of a sub-classification as late-onset bipolar disorder, concerning a clinical case.

Relevant literature was collected from PubMed database under keywords “bipolar disorder”, “late-onset”; “old age” and “age of onset”; the authors reviewed selected articles, publishing dates ranging from 1994 to 2011. Report of a clinical case of a 72 y.o. female patient without previous psychiatric history, admitted for the first time on psychiatric wards, for affective symptoms.

The clinical presentation initially led to the diagnosis of psychotic depression. After treated with antidepressant and atypical antipsychotic, the patient developed mania symptoms and is currently on mood stabilizer.

Although peak incidence of bipolar disorder is around 30 y.o., several studies have suggested a second peak of elderly-presenting cases. Data shows that the later have a greater proportion of medical comorbidities, especially neurological, and of cases with no familial history, which may suggest that these patients belong to a different aetiological sub-group.

Patients with bipolar disorder with onset at older age differ clinically from younger patients, probably due to different aetiological factors. When an elderly patient without previous history of psychiatric disease is admitted for first episode, late-onset bipolar disorder diagnosis must be considered, concerning therapeutic and prognostic implications.