Feature Article Psychiatry and psychology
Sex, drugs and gambling: disinhibition in older people
It is important to understand the older person who presents with disinhibition of mood and behaviour. A careful consideration of possible causes, such as medications, dementia and bipolar disorder, is essential for appropriate management.
- Disinhibition syndromes present with a spectrum of mood and behavioural changes that range from inappropriate behaviour in social situations to full-blown mania.
- Acute mania due to bipolar disorder with onset in early adult life is relatively uncommon in older people.
- In older people, a number of physical aetiologies, in particular medications, are more likely to precipitate disinhibition syndromes.
- Patients with frontotemporal dementia present with disinhibited behaviour early in the disease course, whereas such behaviours are commonly seen in patients in the later stages of Alzheimer’s disease and vascular dementia.
- Lithium remains the treatment of choice in patients with bipolar disorder but its use must be managed carefully in this age group.
- In dementia, there is limited benefit from, and significant risks associated with, the use of antipsychotics.
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