Producing a textbook on bipolar disorder in old age is something of an open goal given the paucity of published material on the subject. This text is a welcome addition. Its stated aim is to provide support to the generalist and subspecialist alike in caring for this complex group of people. The time for such a book is ripe given the push for ‘ageless services’. Whether you view the advent of the ‘ageless service’ as a deplorable manoeuvre aimed at reducing costs regardless of quality (the very definition of a false economy), or as a necessary approach to maintaining service provision: if skills and understanding around managing the complexities of major mental illness in the context of old age across our profession are improved, then this is surely a silver lining at least.
Despite the fact that the majority of authors are based in North America, the book largely avoids being US-centric and is relevant to practice in the UK and other developed health systems. The book is interspersed with clinical vignettes which are a little dry at times but are generally well thought out. There a number of ‘clinical pearls’ sections providing a shortcut for the busy clinician.
The chapters cover all the main bases from epidemiology to clinical management, with a couple of more unexpected outings on the way. The chapter on neuromodulation and ketamine is perhaps intended as something of a wild card to attract fanciers of psychiatric exotica, whereas the chapter on complementary and alternative medicine may split opinion – it is debatable whether a scientific text on the management of a neurobiological disorder is the best place to consider yoga, fish oils and meditation. However, given the increasing interest among our patients, it is necessary for us to have some cursory prior knowledge to navigate what is a strange land for many.
For the serious-minded, clinically focused reader there is plenty of value. The chapter on clinical management has a particularly useful table of medication interactions and advice on negotiating the difficulties of multi-morbidity. The chapter on lithium is insightful and highlights our regrettable underuse of this effective treatment in old age, with a thoughtful review setting the potential adverse effects in a sensible context. Substance misuse is also explored, which is timely given the increasing number of addictions issues in old age.
This book is concise and accessible to the generalist, yet it also provides scientific insights and clinically useful advice to the specialist along with a number of interesting diversions into less-frequented subjects.
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