Bipolar Disorder In Later Life Research Articles

Gene expression alterations in the postmortem hippocampus from older patients with bipolar disorder – A hypothesis generating study

Bipolar disorder (BD) presents with a progressive course in a subset of patients. However, our knowledge of molecular changes in older BD is limited. In this study, we examined gene expression changes in the hippocampus of BD from the Biobank of Aging Studies to identify genes of interest that warrant further exploration. RNA was extracted from the hippocampus from 11 subjects with BD and 11 age and sex-matched controls. Gene expression data was generated using the SurePrint G3 Human Gene Expression v3 microarray. Rank feature selection was performed to identify a subset of features that can optimally differentiate BD and controls. Genes ranked in the top 0.1% with log2 fold change >1.2 were identified as genes of interest. Average age of the subjects was 64 years old; duration of disease was 21 years and 82% were female. Twenty-five genes were identified, of which all but one was downregulated in BD. Of these, CNTNAP4, MAP4, SLC4A1, COBL, and NEURL4 had been associated with BD and other psychiatric conditions in previous studies. We believe our findings have identified promising targets to inform future studies aiming to understand the pathophysiology of BD in later life.

Lithium Dispensed for Adults Aged ≥ 50 Years Between 2012 and 2021: Analyses of a 10% Sample of the Australian Pharmaceutical Benefits Scheme

BackgroundLithium use seems to be declining in clinical practice. We examined the proportion of adults aged ≥ 50 years dispensed lithium between 2012 and 2021, and investigated the proportion of lithium users dispensed other medications. MethodsWe used a 10% random sample data of the Australian Pharmaceutical Benefits Scheme from 2012 to 2021, and limited our analyses to adults aged ≥ 50 years. We retrieved data on lithium, other mood stabilisers, antipsychotics, antidepressants, anxiolytics and hypnotics, and medications for the treatment of other health systems. ResultsWe received 7081939 person-years records (53.2% women). The proportion of participants dispensed lithium decreased with age: 0.4% for those aged 50-59 years to < 0.1% for people aged ≥ 90 years. The dispensing of lithium increased over 10 years for those aged 50-69 and decreased in those older than 80 years. Among people dispensed lithium, nearly 1 in 5 were dispensed another mood stabiliser. Antipsychotics and antidepressants were dispensed to about 60% of participants dispensed lithium, with antidepressants dispensed more frequently to women than men. About 20% of people dispensed lithium were dispensed anxiolytics/hypnotics, more frequently for women than men. Medications to treat diseases of the alimentary, cardiovascular, endocrine and nervous systems were commonly dispensed to those dispensed lithium, as were antibiotics. ConclusionsWhile the dispensing of lithium increased among young older adults since 2015 when guidelines for the management of mood disorders were published, our findings suggest that lithium may be under-utilised for the management of bipolar disorder in later life.

A pilot randomised controlled trial to assess the feasibility and acceptability of recovery-focused therapy for older adults with bipolar disorder.

Despite increasing evidence for the effectiveness of individual psychological interventions for bipolar disorder, research on older adults is lacking. We report the first randomised controlled trial of psychological therapy designed specifically for older adults with bipolar disorder. To evaluate the feasibility and acceptability of recovery-focused therapy, designed in collaboration with older people living with bipolar disorder. A parallel, two-armed, randomised controlled trial comparing treatment as usual with up to 14 sessions of recovery-focused therapy plus treatment as usual, for older adults with bipolar disorder. Thirty-nine participants (67% female, mean age 67 years) were recruited over a 17-month period. Feasibility and acceptability of recruitment, retention (>80% observer-rated outcomes at both 24 and 48 weeks) and intervention processes were demonstrated. The majority of participants started therapy when offered, adhered to the intervention (68% attended all sessions and 89% attended six or more sessions) and reported positive benefits. Clinical assessment measures provide evidence of a signal for effectiveness on a range of outcomes including mood symptoms, time to relapse and functioning. No trial-related serious adverse events were identified. Recovery-focused therapy is feasible, acceptable and has the potential to improve a range of outcomes for people living with bipolar disorder in later life. A large-scale trial is warranted to provide a reliable estimate of its clinical and cost-effectiveness.

Developing a recovery-focused therapy for older people with bipolar disorder: a qualitative focus group study

ObjectivesAs awareness of bipolar disorder (BD) increases and the world experiences a rapid ageing of the population, the number of people living with BD in later life is expected to...

Management of Geriatric Bipolar Disorder: A Case Series and Review of Current Evidence-Based Treatment Guidelines

Bipolar disorder is a severe, relapsing mental illness, with recurrent episodes of altered mood that interfere with cognition and functioning. Although prevalence of bipolar disorder decreases with age, the absolute number of older adults with bipolar disorder is expected to increase with the aging population. Bipolar disorder is a frequent reason for psychiatric hospitalization in later-life, with prevalence rates in psychiatric inpatient treatment settings ranging from 4.7%–18.5%. There are several challenges in the management of geriatric bipolar disorder. Due to physiologic changes, comorbid medical conditions, and often polypharmacy, older adults are at higher risk for adverse effects of medications used to treat bipolar disorder. The disorder itself often impairs insight and treatment adherence. Additionally, response to medication is often incomplete, and later-life bipolar disorder is associated with persisting disability, cognitive impairment, increased mortality, and increased risk of suicide. Finally, limited data are available on use of medications and psychotherapies for older patients with bipolar disorder. Many of the current treatment approaches to bipolar disorder in later life are based on results from clinical trials in younger populations, extrapolated to the geriatric population. During this session, presenters will: 1) Describe current pharmacologic practice patterns and real-world challenges in clinical practice for older adults with bipolar disorder, through summary of a clinical case series of 50 older veterans diagnosed with bipolar disorder and engaged in longitudinal outpatient mental health care at the Minneapolis Veterans affairs medical center; 2) Review the most current literature on evidence-based treatment guidelines for geriatric bipolar disorder; 3) Identify limitations in existing guidelines, through comparison of real-world practice with current research evidence; 4) Propose future steps in geriatric bipolar disorder research that will help fill the existing gaps between the current evidence and clinical practice.

MANAGEMENT OF GERIATRIC BIPOLAR DISORDER: A CASE SERIES AND REVIEW OF CURRENT EVIDENCE-BASED TREATMENT GUIDELINES

Bipolar disorder is a severe, relapsing mental illness, with recurrent episodes of altered mood that interfere with cognition and functioning. Although prevalence of bipolar disorder decreases with age, the absolute number of older adults with bipolar disorder is expected to increase with the aging population. Bipolar disorder is a frequent reason for psychiatric hospitalization in later-life, with prevalence rates in psychiatric inpatient treatment settings ranging from 4.7%–18.5%. There are several challenges in the management of geriatric bipolar disorder. Due to physiologic changes, comorbid medical conditions, and often polypharmacy, older adults are at higher risk for adverse effects of medications used to treat bipolar disorder. The disorder itself often impairs insight and treatment adherence. Additionally, response to medication is often incomplete, and later-life bipolar disorder is associated with persisting disability, cognitive impairment, increased mortality, and increased risk of suicide. Finally, limited data are available on use of medications and psychotherapies for older patients with bipolar disorder. Many of the current treatment approaches to bipolar disorder in later life are based on results from clinical trials in younger populations, extrapolated to the geriatric population. During this session, presenters will: 1) Describe current pharmacologic practice patterns and real-world challenges in clinical practice for older adults with bipolar disorder, through summary of a clinical case series of 50 older veterans diagnosed with bipolar disorder and engaged in longitudinal outpatient mental health care at the Minneapolis Veterans affairs medical center; 2) Review the most current literature on evidence-based treatment guidelines for geriatric bipolar disorder; 3) Identify limitations in existing guidelines, through comparison of real-world practice with current research evidence; 4) Propose future steps in geriatric bipolar disorder research that will help fill the existing gaps between the current evidence and clinical practice.

Risk of developing major depression and bipolar disorder among adolescents with atopic diseases: A nationwide longitudinal study in Taiwan

BackgroundsPrevious studies have found an increased prevalence of atopic diseases among patients with major depression and bipolar disorder. But the temporal association between atopic diseases in adolescence and the subsequent risk of developing mood disorders has been rarely investigated. MethodsUsing the Taiwan National Health Insurance Research Databases, 5075 adolescents with atopic diseases (atopic cohort) and 44,729 without (non-atopic cohort) aged between 10 and 17 in 2000 were enrolled into our study and followed to the end of 2010. Subjects who developed major depression or bipolar disorder during the follow-up were identified. ResultsThe atopic cohort had an increased risk of developing major depression (HR: 2.45, 95% CI: 1.93~3.11) and bipolar disorder (HR: 2.51, 95% CI: 1.71~3.67) compared to the non-atopic cohort, with a dose-dependent relationship between having a greater number of atopic comorbidities and a greater likelihood of major depression (1 atopic disease: HR: 1.80, 95% CI: 1.29~2.50; 2 atopic comorbidities: HR: 2.42, 95% CI: 1.93~3.04;≥3 atopic comorbidities: HR: 3.79, 95% CI: 3.05~4.72) and bipolar disorder (HR: 1.40, 95% CI: 0.57~3.44; HR: 2.81, 95% CI: 1.68~4.68; HR: 3.02, 95% CI: 1.69~5.38). DiscussionHaving atopic diseases in adolescence increased the risk of developing major depression and bipolar disorder in later life. Further studies may be required to clarify the underlying mechanism between atopy and mood disorders, and to investigate whether prompt intervention may decrease the risk of subsequent mood disorders.

Risk of bipolar disorder among adolescents with allergic rhinitis: A nationwide longitudinal study

BackgroundPrevious studies have suggested an immunological dysfunction in bipolar disorder, but none has investigated the temporal association between allergic rhinitis (AR) and bipolar disorder. MethodsUsing Taiwan National Health Insurance Research Database, 9506 adolescents aged 12–18years with allergic rhinitis were enrolled between 2000 and 2008 and compared to 38,024 age-and gender-matched (1:4) control groups. Subjects of bipolar disorder that occurred up to the end of follow-up (December 31, 2011) were identified. ResultsAdolescents with AR had a significantly higher incidence of developing bipolar disorder (0.77 vs. 0.18 per 1000 person-years, p<0.001) during the follow-up period than the controls. Adolescents with AR had an increased risk (hazard ratio [HR]: 4.62, 95% confidence interval [CI]: 3.17–6.75) of developing bipolar disorder in their later life compared to the control group after adjusting for demographic data and comorbid allergic diseases. DiscussionThis is the first study showing a temporal association between AR and bipolar disorder, in that patients who had AR in adolescence exhibited an increased risk of developing bipolar disorder in later life. Further study would be required to investigate the underlying mechanism about this association.

Comorbidity of ADHD and subsequent bipolar disorder among adolescents and young adults with major depression: a nationwide longitudinal study.

Previous studies have found that attention-deficit hyperactivity disorder (ADHD) in childhood and adolescence is associated with an increased risk of major depression and bipolar disorder in later life. However, the effect of ADHD comorbidity on the diagnostic conversion to bipolar disorder among patients with major depression is still uncertain. Using the Taiwan National Health Insurance Research Database, 58,023 subjects < 30years of age who had major depression with (n=1,193) or without (n=56,830) ADHD comorbidity between the years 2000 and 2008 were enrolled in our study. Subjects who developed bipolar disorder during the follow-up to the end of 2011 were identified. Adolescents and young adults who had major depression with ADHD comorbidity had an increased incidence of subsequent bipolar disorder (18.9% versus 11.2%, p<0.001) compared to those without ADHD. Cox regression analysis showed that ADHD comorbidity was an independent risk factor (hazard ratio=1.50, 95% confidence interval 1.30-1.72) predicting subsequent bipolar disorder among those with major depression, adjusting for demographic data and psychiatric comorbidities. Patients with comorbid diagnoses of major depression and ADHD had an increased risk of diagnostic conversion to bipolar disorder compared to those who had major depression alone. Further studies would be required to validate this finding and to investigate the possible underlying mechanisms.

Higher risk of developing major depression and bipolar disorder in later life among adolescents with asthma: A nationwide prospective study

ObjectivePrevious studies have suggested an immunological dysfunction in mood disorders, but rarely have investigated the temporal association between allergic diseases and mood disorders. Using the Taiwan National Health Insurance Research Database, we attempted to investigate the association between asthma in early adolescence and the risk of unipolar depression and bipolar disorder in later life. MethodsIn all, 1453 adolescents with asthma aged between 10 and 15 years and 5812 age-/gender-matched controls were selected in 1998–2000. Subjects with unipolar depression and bipolar disorder that occurred up to the end of follow-up (December 31 2010) were identified. ResultsAdolescents with asthma had a higher incidence of major depression (2.8% vs. 1.1%, p < 0.001), any depressive disorder (6.1% vs. 2.6%, p < 0.001), and bipolar disorder (1.0% vs. 0.3%, p < 0.001) than the control group. Cox regression analysis showed that asthma in early adolescence was associated with an increased risk of developing major depression (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.14–2.89), any depressive disorder (HR: 1.74, 95% CI: 1.27–2.37), and bipolar disorder (HR: 2.27, 95% CI: 1.01–5.07), after adjusting for demographic data and comorbid allergic diseases. DiscussionAdolescents with asthma had an elevated risk of developing mood disorders in later life. Further studies would be required to investigate the underlying mechanisms for this comorbid association and elucidate whether prompt intervention for asthma would decrease the risk of developing mood disorders.

Late-Life Bipolar Disorder

As our society ages, it is critical that we expand our understanding of how best to provide care and services for the growing population of elderly patients with bipolar disorder (BD). For many years, there was a dearth of publications focused on the topic of late-life BD. Indeed, the current literature base on geriatric BD is still insufficient to address critical questions regarding etiology, assessment, treatment, and prognosis. In this special issue, we focus on BD in later life and present a series of articles that we believe will be of interest to clinicians and researchers. In the first article, Al Jurdi and colleagues used data from the National Institute of Mental Health-funded Systematic Treatment Enhancement Program for BD (STEP-BD) and compared the presence and severity of acute mood elevation (mania and hypomania) and acute depression symptoms between younger (20-59 years old) and older individuals ( 60 years old). With the exception of distractibility, all acute depression symptoms presented with comparable frequency and severity between younger and older individuals. Huang and colleagues examined the rate of silent cerebral infarctions and risk factors for cerebral infarction in 43 elderly patients with BD using whole-brain magnetic resonance imaging. Their analyses focus on the relationships between cerebral vascular disease, metabolic illness, and bipolarity. Their analyses support the understanding that there are shared neuroprogressive pathways that underlie vascular medical comorbidity, cognitive dysfunction, and mood dysregulation in BD. Lala and Sajatovic summarize the literature on comorbidity in bipolar adults aged >50 years. Psychiatric comorbidity rates appear lower than in younger BD populations, with the most common concurrent illnesses being anxiety and substance use disorders. While older adults with BD have on average of 3 to 4 medical comorbid conditions, medical condition rates appear similar among geriatric patients with and without BD. Avari and Young present a case report of BD in a patient with antiphospholipid syndrome (APS). They present this case in the context of one previous case report and literature linking APS-related immune markers to various neuropsychiatric disorders. They discuss potential vascular and direct mechanisms pertinent to an association of APS with BD, if demonstrated. They encourage additional case descriptions and suggest possible systematic studies. Bhalerao and colleagues report on mortality risk with use of atypical antipsychotics in geriatric BD. US national data from the Department of Veterans Affairs included registry information on 4717 patients 65 years and identified 6-month mortality rates with a new start of an atypical antipsychotic or valproic acid and derivatives during fiscal years 2001 to 2008. The authors report differences in mortality risks among individual antipsychotic agents, a finding that clearly demonstrates the need for continued investigation on currently used psychotropic agents in bipolar elders. Gildengers and colleagues present a secondary analysis from clinical trial data on correlates of treatment response in depressed older adults with BD. They are interested in whether an agent such as lamotrigine that appears to reduce oxidative stress is particularly effective in patients with high vascular medical comorbidity in the context of depressive illness. They present an approach to target treatment to those individuals who may respond most robustly to this type of intervention. Using a novel imaging technique, phosphorus magnetic resonance spectroscopy, Forester and colleagues examine bioenergetic pathways related to bipolar depression in older adults. They look at whether the forward rate constant of creatine kinase (kfor) is altered in older adults with bipolar depression and whether CoEnzyme Q 10, known to have properties that enhance mitochondrial function, increases kfor in older bipolar individuals compared with untreated ageand sex-matched controls. Their study builds on the growing interest in dysfunctional mitochondrial energy metabolism in BD. Rej and Shulman present a systematic review of all studies pertaining to the effects of lithium on the kidney in older adults. They note that age-specific studies are few and conclude that there is no compelling evidence for general avoidance of use of lithium in elderly individuals based on concerns about renal effects. They suggest guidelines for the approach to lithium management in elderly individuals. Finally, Al Jurdi and colleagues conducted a secondary analysis based upon the baseline data from 100 bipolar elderly individuals participating in a pharmacologic treatment Journal of Geriatric Psychiatry and Neurology 25(1) 4-5 a The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0891988712439691 http://jgpn.sagepub.com

A renovation of psychiatry is needed

Strakowski et al carefully discuss the benefits and risks of broadening the diagnosis of bipolar disorder, from treatment and research perspectives. Their conclusion that it is premature to broaden the bipolar disorder diagnosis before the identification of an etiology common to bipolar spectrum disorders is quite reasonable. It is theoretically apparent that patients currently receiving a diagnosis of “major depression” include those who will develop bipolar disorder in later life. However, those patients cannot be identified just by clinical interviews. Only after the neurobiological basis of bipolar disorder is discovered and an in vivo identification of such neurobiological signature becomes feasible, it will be possible to reliably diagnose potential bipolar disorder in depressive patients. If we make a bipolar spectrum disorder diagnosis based solely on clinical interview, false positive cannot be avoided. Some patients might benefit from a correct diagnosis of potential bipolar disorder, but others will be misdiagnosed and receive inadequate treatment. Recently, family and genome wide association studies have shown that bipolar disorder and schizophrenia share some common genetic background. The risk of schizophrenia is increased in first-degree relatives of probands with bipolar disorder, and the risk of bipolar disorder is increased in first-degree relatives of probands with schizophrenia, with relative risks between 2.4 and 5.2 1. In the study by the International Schizophrenia Consortium, the involvement of thousands of common alleles of very small effect was suggested in schizophrenia. It was shown that this polygenic component also contributes to the risk of bipolar disorder 2. This finding apparently supports the idea of a continuum between these two disorders. However, it should be noted that 7% of patients with schizophrenia were also diagnosed as having bipolar disorder in the former study. Can we discriminate between “existence of common pathology between these two disorders” and “difficulty in differential diagnosis of these two disorders” using currently available research schemes? If we loosen the diagnostic boundary based on the interpretation that these two disorders share common pathology, future research will suffer from lack of adequate clinical validity. If we deconstruct psychosis and combine these two disorders, we will only return to the chaos before Kraepelin. We psychiatrists have been trying to differentiate mental disorders based on clinical interviews since the era of Kraepelin. After an extensive effort, we realize now that our diagnostic criteria are not perfect. Because there was little progress in psychiatric diagnosis in the last century, refinement of DSM can make only modest improvement, if any. To further refine psychiatric diagnosis, the only way is to establish a new disease classification based on the neurobiological features of each mental disorder. A recent study of 153 brains of non-demented elderly people reported that patients receiving a diagnosis of depression during their life by interview showed more Lewy bodies in locus coeruleus. At the same time, neurofibrillary tangles were also more frequently seen in this region 3. Can we differentiate depression in the early stages of diffuse Lewy body or Alzheimer’s disease from depression without neuropathology only by clinical interviews? We psychiatrists should be aware that we cannot identify “diseases” only by interviews. What we are doing now is just like trying to diagnose diabetes mellitus without measuring blood sugar. Medicine is fundamentally based on pathology. Psychiatry should also be based on pathology rather than psychology. When the concept of Alzheimer’s disease was established more than 100 years ago, there were few staining methods, such as silver and Nissl staining. After one century, we have completely sequenced the human genome, and we can potentially stain tens of thousands of molecules in the brain by mRNA in situ hybridization or immunohistochemistry. All the technologies we need to refine psychiatry have already been established. What we should do is to study the neurobiological basis of mental disorders using updated technologies and give rise to the renovation in psychiatry.

The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th ed.

Back to table of contents Previous article Next article Book ForumFull AccessThe American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th ed.Helen C. Kales, M.D.Helen C. KalesSearch for more papers by this author, M.D.Published Online:1 May 2010https://doi.org/10.1176/appi.ajp.2009.09091340AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail edited by BlazerDan G. and SteffensDavid C.. Washington, D.C., American Psychiatric Publishing, Inc., 2009, 694pp., $164.00. Our nation is entering a "tsunami" of aging. By 2030, it is estimated that over 80 million Americans, or 20 percent of the population, will be 65 years of age or older. With advancing age comes medical and neurological complexity, and given that there is a shortage of geriatric psychiatry specialists, it will be increasingly necessary for general psychiatrists to have a working knowledge of issues germane to the care of the many older patients in their practices.The fourth edition of the American Psychiatric Publishing Textbook of Geriatric Psychiatry is a timely and relevant addition to the literature for both geriatric and general psychiatrists, as well as other providers who treat older patients. As with the third edition published in 2004, the text is divided into five sections (basic science, diagnostic interviewing, later-life psychiatric disorders, treatment, and legal, ethical, and policy issues) but is revised and expanded. Newly added chapters include those on delirium, dementia and other cognitive syndromes, and bipolar disorder in later life. Also new to this edition are helpful summary points and suggested additional readings at the end of each chapter.All of the chapters provide solid and eminently readable reviews of the topics covered, but there are a number of chapters that are standouts. The chapter on neuroanatomy by Taylor, Moore, and Chin provides a stellar review for the clinician, with clear and concise descriptions of the anatomical regions of the brain and associated neuropathological changes seen in later-life conditions, accompanied by illustrative figures and pictures. The subsequent chapter on chemical messengers by Kilts et al. presents the major neurotransmitters and their localizations and highlights their physiological impacts. A chapter by Fearing and Inouye covers delirium and provides an understanding for the pathophysiology surrounding this all-too-familiar syndrome seen in older patients, as well as the current evidence base relevant to prevention and treatment for this condition. Lyketsos authored the masterful chapter on dementia, which includes a decoding for the nonspecialist of the various terms used to describe memory disturbances, such as cortical versus subcortical subsyndromes, and descriptions of the major types of dementia as well as presentation of the "four pillars of dementia care" (disease management, symptom management, supportive patient care, and attention to caregiver issues). The chapter on anxiety disorders by Lenze and Wetherell nicely organizes later-life syndromes into those characterized by worry/distress (generalized anxiety disorder, posttraumatic stress disorder), fear (panic disorder, agoraphobia, social phobia, and specific phobias), and obsessive-compulsive disorder. The section on clinical management of anxious older patients is excellent and includes the observation that medication "intolerance" in many anxious patients may often result from anticipatory side effect worries and hypervigilance about bodily sensations. Providers seeing older psychiatric patients would benefit from reading Oslin and Mavandadi's chapter on recognizing and treating alcohol and drug problems in older adults to help them understand the impact of the aging baby-boomer generation on our practices. The chapter on psychopharmacology by Mulsant and Pollack is outstanding, discussing all the commonly used agents in later-life psychiatric conditions, including their cytochrome P450 actions. They also provide thorough coverage of the morbidity and mortality concerns of using antipsychotics in the elderly. Other highlights included in the text are chapters on nutrition and physical activity and their links to mental and cognitive health; adapting psychotherapies to older adults; and working with families of older adults (including how to deal with the difficult issue of limitations on driving).There are a few areas that could be improved. Given the heterogeneity of later-life depression, areas that would merit more coverage include how the clinical presentation of depression can differ from standard DSM criteria; the concept of executive dysfunction, including bedside assessment; problems of adherence to treatment; and the areas of prevention and positive or successful aging. It is likely that these issues will be more fully addressed in the coming years in subsequent editions by the editors and contributors to this excellent textbook.Ann Arbor, Mich.The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited ByNone Volume 167Issue 5 May 2010Pages 604-604 Metrics PDF download History Accepted 1 September 2009 Published online 1 May 2010 Published in print 1 May 2010

Bipolar Disorder in Later Life

Bipolar Disorder in Later Life

Parenting an Adult Child With Bipolar Disorder in Later Life

This study extends prior research on family caregiving in mental illness by investigating late-life parenting of adult children with bipolar disorder using a randomly selected community-based sample. The health and mental health, psychological well-being, marriage, work-life, and social resources of 145 parents of adult children with bipolar disorder were examined when parents were in their mid-60s. Stratified random sampling procedures were used to select a comparison group whose children did not have disabilities. Results indicate that parents of adult children with bipolar disorder had a more compromised profile of health and mental health, and experienced more difficulties in marriage and work-life than comparison parents. Furthermore, parents of adult children with bipolar disorder who were diagnosed with mental illness before the onset of their child's symptoms were more vulnerable on multiple dimensions of mental health, psychological well-being, and work-life than parents without a preexisting mental illness.

Book Review: Bipolar Disorder in Later Life

Bipolar Disorder Bipolar Disorder in Later Life Martha Sajatovic and Frederic C Blow, editors. Baltimore (MD): The Johns Hopkins University Press; 2007. 257 p. US$50.00 Reviewer rating: Excellent Review by Kenneth Shulman, MD Toronto, Ontario One of the chapters in this comprehensive and timely text on bipolar disorder in later life uses the apt subtitle, Navigating Terra Incognita. This is an underlying theme to the entire text, as the evidence base for understanding the nature and management of bipolar disorders in later life is very limited. Nonetheless, the authors have compiled this text because late-life bipolar disorders are associated with poor social outcomes, significant medical comorbidities, and increased health care costs. The book is carefully edited by Martha Sajatovic, a well-known American researcher in late-life bipolar disorders, and Frederic Blow, director of the National Serious Mental Illness Treatment Research and Evaluation Center in the Veterans Affairs System in Michigan. They bring together a vast amount of research and clinical experience, directly and indirectly related to bipolar disorders in older adults. The text is divided into 4 sections including: epidemiology and assessment, treatment, complexity and comorbidity, and specialized care delivery and research. One of the prominent themes and issues that emerge is the question of burnout and age of onset of later life bipolar disorders. The authors argue that these disorders do not burnout, but remain a significant concern in later life. Really, the question is: Do early onset bipolar disorders burnout as they grow old? For this the evidence is quite mixed depending on whether one uses an outpatient or inpatient sample. However, the authors make the valid point that the burden of bipolar disorder in old age does not burnout or diminish. Sajatovic and colleagues used a large Veteran's Affairs database in the United States to document the heavy cost of health services by older bipolar patients, including their medical and psychiatric comorbidities. Curiously, they found that early onset patients in the Veteran's Affairs database seem to create a greater burden than late onset cases. Just why this should be adds yet another important and unanswered question to the many posed in this book. Age of onset remains an important variable that helps to identify different factors relevant to the pathogenesis and etiology of bipolar disorders across the lifespan. Perhaps the best chapter in the book is the one written by the editors themselves: Epidemiology of Bipolar Disorder in Later Life. This is a concise and well-written chapter that addresses gender differences, outcomes in the use of health services, clinical presentation, comorbidity, barriers to care, and treatment. Each of these subsections is addressed more completely in separate chapters. The book highlights numerous interesting and unique approaches to understanding bipolar disorders. …

Bipolar Disorder in Later Life

Bipolar Disorder in Later Life

Bipolar Disorder in Later Life

Back to table of contents Previous article Next article Book ReviewsFull AccessBipolar Disorder in Later LifeStephen L. Pinals M.D.Jason B. Strauss M.D.Stephen L. Pinals M.D.Search for more papers by this authorJason B. Strauss M.D.Search for more papers by this authorPublished Online:1 Jan 2008https://doi.org/10.1176/ps.2008.59.1.119AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The lack of evidence-based research available to guide clinicians in treating people with geriatric mental illnesses is striking. This is very much the case with regard to late-life bipolar disorder. Contrary to the popular notion that bipolar disorder "burns out" over time, this condition is becoming increasingly prevalent among elderly people as this segment of the population grows. Martha Sajatovic from Case Western Reserve University and Frederic Blow from the University of Michigan, two leaders in this burgeoning field, fill a gaping void with their book Bipolar Disorder in Later Life . Sajatovic and Blow recruited many experts and colleagues in geriatric bipolar research to create a comprehensive, cohesive, and crisply written work. This text will be of significant value to any clinician caring for this population, including general and geriatric psychiatrists, as well as geriatricians at all levels of training and expertise. The editors' stated purpose is to "present the most up-to-date knowledge available, provide frameworks and resources with which to understand bipolar disorder in late life, and offer guidance to address the paucity of data on this topic." This purpose is achieved in an eminently readable manner, because the book is divided into four parts. In the first section, the editors introduce us to the epidemiology and assessment of late-life bipolar disorder. This is followed by a concise synopsis of the use and utility of mood-rating scales in assessing mania in geriatric bipolar disorder, provided by Robert Young and colleagues.The second section concentrates on the treatment of late-life bipolar disorder, beginning with a summary of the different presentations of mania seen among elderly persons. The authors review the limited data that exist on the biological treatment of late-life bipolar disorder. Indeed, to date there has not been a single placebo-controlled trial of any agent in this population. Nevertheless, the authors do an excellent job of piecing together the available information to provide a framework for clinicians to treat geriatric bipolar disorder, focusing on minimizing potential adverse effects. The rest of this section includes valuable chapters on psychosocial interventions and treatment adherence.The third section focuses on the many challenges of treating geriatric patients with bipolar disorder with active substance abuse and medical comorbidities. Helen Kales provides a useful and clearly written summary of the various medical conditions that often accompany the presentation of late-life bipolar disorder. This section concludes with a timely and interesting account of how culture may affect the diagnosis and treatment of bipolar disorder among elderly persons.Among the concluding chapters is a review of the significant obstacles that researchers face in filling the gaps that remain in geriatric bipolar research and care. The reader is made aware of the uneven quality of psychiatric and medical care in this special population and the dearth of adequate quality control indicators to assess these issues.Bipolar Disorder in Later Life is an exceptionally well-written and thorough review of this emerging focus of research. Both clinicians and academicians will find it to be a necessary and useful work in its own right, and we hope that it leads to continued advances in the field. Dr. Pinals is associate director of geriatric psychiatry at Cambridge Health Alliance and a clinical instructor in psychiatry at Harvard Medical School, Cambridge, Massachusetts, and Dr. Strauss is a geriatric psychiatry fellow at Cambridge Health Alliance. FiguresReferencesCited byDetailsCited byNone Volume 59Issue 1 January, 2008Pages 119-120PSYCHIATRIC SERVICES January 2008 Volume 59 Number 1 Metrics PDF download History Published online 1 January 2008 Published in print 1 January 2008

Cognitive impairment in later life in patients with early‐onset bipolar disorder

Cognitive impairment may interfere with psychosocial functioning in bipolar disorder (BD). There is limited information regarding the cognitive function of elderly bipolar patients with onset at a young age. The present study aimed to investigate the frequency and the determinants of cognitive impairment in elderly early-onset bipolar patients. Using the Clock-drawing Test (CDT), the Mini Mental State Examination (MMSE), and the Cognitive Abilities Screening Instrument (CASI), we examined euthymic patients with bipolar I disorder in Taiwan, aged 60 years and older. Clinical data were obtained by reviewing medical records and personal interviews with patients and their family members. The onset of BD prior to the age of 40 years is defined as 'early-onset'. Of the 52 early-onset patients, 42.3% were determined to have cognitive impairment by exhibiting either abnormal CDT or education-adjusted MMSE scores. In a multiple regression model, years of education and the age at the last manic/hypomanic (but not depressive) episode accounted for the greatest variance in both MMSE and CASI scores. While educational level and the age at the last manic/hypomanic episode were not considered in the regression model, onset with depressive syndrome and current age explained 21.5% of the variance in MMSE scores. Age at the first depressive episode, the first manic episode before the age of 40 years, and comorbid diabetes accounted for 16.7% of the variance in CASI scores. There appeared to be a sizable proportion of elderly early-onset bipolar patients having cognitive impairment. It is suggested that clinical manifestation of first-onset affective episode and impact of medical comorbidity affect the cognition of early-onset BD in later life.

Bipolar Disorder in Later Life

Bipolar Disorder in Later Life