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A review of the patient’s medications, including prescribed, over-the-counter, and supplements, is vital to identify agents that may contribute to mood change in the elderly. A consideration of social factors, life changes, and the presence of comorbid neurologic or medical symptoms is paramount. Initial or screening laboratory tests include an electrolyte panel, fasting serum glucose level, liver function tests, creatinine level, complete blood count, thyroid-stimulating hormone level, vitamin B12 and folic acid levels, electrocardiography, chest radiography, urinalysis, and a urine drug screen and serum drug screen if warranted.

Appropriate, prompt diagnosis and treatment of latelife mood disorders can significantly improve the quality of life of patients and families and may prove life saving. Current treatments can help most older adults with mood disorders. Future treatments are promising, particularly for those with treatment-resistant depression. References [1] Hybels CF, Blazer DG. Epidemiology of late life mental disorders. Clin Geriatr Med 2003; 19(4):663–96. [2] Burke WJ, Wengel SP. Late life mood disorders. Clin Geriatr Med 2003;19(4):777–97.

18] Lapid MI, Rummans TA. Evaluation and management of geriatric depression in primary care. Mayo Clin Proc 2003;78:1423–9. [19] Wylie M, Mulsant B, Pollock B, et al. Age at onset in geriatric bipolar disorder: effects on clinical presentation and treatment outcomes in an inpatient sample. Am J Geriatr Psychiatry 1999;7(1):77–83. [20] Young R, Klerman G. Mania in late life: focus on age at onset. Am J Psychiatry 1992;149: 867–76. [21] Shulman K, Herrmann N. The nature and management of mania in old age.

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