Balancing the highs and lows: Diagnostics, understanding and treatment of recurrence in older adults with bipolar disorder

The first aim of this thesis was to expand our knowledge on the diagnostics and assessment methods in OABD. With this aim, we first examined whether different depression scales can be harmonized in order to create larger datasets. Then, we examined the reliability and validity of the Functioning Assessment Short Test (FAST) for Older adults (FAST-O). Next, we compared cognitive functioning in OABD with cognitive functioning in late life depression and healthy controls. The second aim of our thesis was to create a greater understanding of the clinical phenotype in OABD and its mutual interactions. For this aim, we first examined the relationship between cognitive and social functioning in OABD. Thereafter, we studied the influence of social, psychological and cognitive factors on the clinical course in OABD. Next, we studied psychiatric symptoms during the COVID-19 outbreak in OABD and at last, we studied the course of these psychiatric symptoms in OABD during the first 6 months of the COVID-19 pandemic. Our third aim was to assess the feasibility and acceptability of new treatment approaches in OABD. We first examined a group intervention for mild cognitive impairment in OABD and thereafter we studied an intervention of group interpersonal and social rhythm therapy (IPSRT) for recurrent mood disorders. All in all, this thesis shows the population of OABD is a distinct and complex group. However, with the appropriate adjustments, currently existing diagnostic instruments and treatment strategies can be adapted in order to be used in the OABD group. There is still a lot unknown in the OABD group, but results show that progress can be gained in this field of research. Since OABD patients show great variability in clinical phenotype, it is always important to not blindly follow findings from treatment studies or guidelines and to try to never lose sight of the individual patient