Клинические особенности биполярного аффективного расстройства у госпитализированных больных позднего возраста

Abstract

Background: as a result of global population aging the amount of aged patients with bipolar disorder (BD) is gradually growing both with the disease onset in the first half of life and with disease onset after 60 years. Aim of the study was to observe clinical features and course of BD in elderly. Material and methods: continuous sample of bipolar in-patients of geriatric clinical units of MHRC aged 60 and older (n = 146) in 2014–2017 were included to comparative study. According to the aim and tasks of the study the patients were divided into 3 groups depending on the age of BD onset: with early-onset BD (0–49 years), new onset in the involution period (50–59 years) and with late-onset BD (60 years and older). All of the patients were examined by psychopathological, clinical and psychometrical method (Hamilton Depression Rating Scale — HAM-D, Hamilton Anxiety Rating Scale — HARS, Young Mania Rating Scale — YMRS, Mini-Mental State Examination — MMSE and Montreal Cognitive Assessment — MoCA). Results: early-onset BD (0–49 years) occurred in 92 patients (63%), new-onset BD in involution period (50–59 years) — in 35 cases (24%), late-onset BD (60 years and older) — in 19 patients included to the study (13%). Early-onset BD was more common in men, while new onset in the involution period — in women. Late-onset BD occurred in men and women with equal frequency. In the majority of patients BD started with depressive episode. Mixed affective episodes showed to be more common as a first BD episode with the increase of disease onset age. Age features of clinical course of affective episodes, cognitive functioningand premorbid characteristics of enrolled patients were viewed and discussed in the study. Early-onset BD leads to more frequent affective episode formation in elderly up to rapid cycling forms, while late-onset BD leads to more prolonged clinical course of affective episodes in comparison with early-onset BD. Premorbid features occur more often in patients with disease onset in thefirst half of life than in patients with late-onset BD. Cognitive functioning of all observed patients stay under age norm during intermission. Conclusion: BD can have its onset at every age, even after 60 years, though in the majority of patients BD onsets before 50 years. Due to ageing, regardless to the age of disease onset depressions and manias in all elderly patients get age-related patterns, mixed affective states become more common.