Treatment of Acute Mania With Aripiprazole in an Older Adult With Noted Improvement in Coexisting Parkinson's Disease

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Sir:We describe a patient in a skilled nursing facility who had symptomexacerbation of bipolar disorder while taking divalproex and olanzapine.The patient was treated with a combination of aripiprazole and divalproexafter discontinuation of olanzapine.Case report. Ms. A, a 64-year-old single, white, female resident of askilled nursing facility, was admitted to the inpatient psychiatric unit due topsychotic symptoms characterized by delusions (claims that she had beensexually active in the nursing facility and was pregnant) and impaired judgment. The patient had a DSM-IV diagnosis of bipolar affective disorder withpsychotic symptoms.