Late-onset Bipolar Disorder Research Articles

Bipolar Disorder in Older Adult Inpatients

The literature on bipolar disorder in older adults is very limited, in spite of the fact that the elderly are a growing population in the United States. This retrospective record review study evaluated clinical characteristics and hospital-based resource use patterns among 48 older adults with bipolar disorder, and compared groups with early-onset (EOS) versus late-onset (LOS) bipolar disorder. The mean age of the group was 67.3 years, with no difference in age between EOS and LOS categories. Late onset illness was identified in 29.2% of the group (N = 14). Compared with individuals with EOS, individuals with LOS were 2.8 times more likely to be female. Both groups had extensive medical comorbidity (mean of 3.7 comorbid medical conditions), substantial hospital usage (mean length of stay, 14.8 days) and polypharmacy usage. Bipolar disorder with onset after age 50 is not uncommon among older adults hospitalized on a geropsychiatric unit. Clinical characteristics may differ between individuals with early-onset and late-onset bipolar illness, and resource utilization may be extensive in both groups.

Bipolar Disorder in Middle-Aged and Elderly Adults: Is Age of Onset Important?

The literature is mixed about whether age of onset is a useful variable in explaining the heterogeneity of late-life bipolar disorder. The aim of this study was to examine the relationship of age of onset with clinical, family history, and neuropsychological functioning in middle-aged and older patients with bipolar disorder. A total of 87 outpatients with bipolar disorder with a mean age of 59 (range, 42-89) were included in this study. Age of onset was analyzed as a continuous variable and was split at age 40 years into early-onset and late-onset groups. Participants were administered measures of psychopathology, cognitive functioning, and medication usage. Few meaningful differences emerged between early-onset and late-onset groups, except that overall psychopathology was significantly lower in the late-onset group. Age of onset did not relate to differences in family history, depressive symptoms, cognitive functioning, or medication use whether used as a categorical or continuous variable. Thus, the validity of late-onset bipolar disorder as a distinct syndrome was not corroborated by this study. Interpretation of these findings is limited by the sample size, cross-sectional design, and a lack of brain imaging data. Further research on the clinical features and neurobiological aspects of late-life bipolar disorder is needed.

Transtorno bipolar de início tardio: uma variedade orgânica do transtorno de humor?

Bipolar disorder (BD) is commonly associated with late adolescence or early adulthood, although a substantial proportion of patients develops the condition in later life. The results of early clinical investigations suggested that cases of bipolar disorder with onset in later life were more often associated with 'organic causes', and could potentially justify the distinction between early and late onset bipolar disorder. This paper reviews currently available evidence in support of the organic hypothesis for late onset bipolar disorder. It concludes that the split of bipolar disorder according to age at onset is artificial, and lacks clinical significance and epidemiological support.

Age at Onset May Define Bipolar Disorder Subgroups

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessAge at Onset May Define Bipolar Disorder SubgroupsJim RosackJim RosackSearch for more papers by this authorPublished Online:6 Jun 2003https://doi.org/10.1176/pn.38.11.0038A new research report confirms earlier data suggesting that bipolar I disorder exists as three distinct subgroups, defined by age at onset.The course and presentation of bipolar I disorder—marked by at least one manic or mixed episode often accompanied by one or more major depressive episodes—have often been described as variable, in terms of both symptoms and response to treatment. Researchers have postulated the existence of an early-onset bipolar disorder that may be associated with a greater familial risk of affective disorders, including bipolar disorder; higher rates of comorbid conditions such as psychotic symptoms, panic disorder, conduct disorder, and substance abuse; and a poor response to treatment, usually including lithium resistance.In addition, suicidal behaviors are thought to be more closely linked to early-onset than late-onset bipolar disorder. Several researchers have also reported preliminary evidence attempting to associate early- or late-onset forms of bipolar disorder with specific genetic risk factors. All of these associations appear to result in a poor prognosis.Despite the increasing amount of data published on this topic in the last decade, researchers still have not established a firm threshold for age at onset that can be used in clinical, biological, or familial studies.The latest report, from Frank Bellivier, M.D., Ph.D., a professor of psychiatry at the Henri Mondor Hospital in Cedex, France, appeared in the May American Journal of Psychiatry.Bellivier and his colleagues presented data on 368 patients with bipolar I disorder, followed prospectively upon admission to three centers (one each in France, Switzerland, and Germany) from 1994 to 2001. In addition, the researchers recruited 130 patients with bipolar I disorder belonging to 59 sibling pairs from treatment centers in Ireland, Germany, and France from 1992 to 1997.The same research team reported preliminary data in the May 2001 Archives of General Psychiatry on 211 patients with bipolar I disorder in which they postulated three subgroups for the disorder, characterized by age at onset. In that preliminary report they defined the three groups as having mean ages of onset of 16.9 years (41.4 percent of the 211 patients), 26.9 years (41.9 percent), and 46.2 years (16.6 percent).For the 368 patients reported in the current study, the researchers again found a distribution grouped around three mean ages that was not statistically different from the ages in the 2001 report. The age of onset of the current group of patients were clustered around 17.6 years (21.4 percent of the 368 patients), 24.6 years (57.3 percent), and 39.2 years (21.2 percent).The French researchers pooled two independent populations and calculated a best-fitting distribution model of 17.4, 25.1, and 40.4 years.When the 59 sibling pairs were analyzed to compare age at onset between siblings, the researchers found that affected siblings were highly likely to belong to the same age-at-onset group.They then grouped all affected families and assigned each to the age-at-onset group to which it had the highest probability of belonging. Twenty-eight of the 59 families (47.5 percent) belonged to the early-onset group, 29 families fit into the intermediate-onset group (49.2 percent), and two families (3.4 percent) were classified in the late-onset group.The investigators believe that all three independent populations—the original 2001 study of 211 patients, the current report of 368 patients, and the concurrent 59 sibling pairs—provide supporting evidence for their three-subgroup model, defined by age at onset.“This strongly suggests the existence of three genuine age-at-onset subgroups for patients with bipolar affective disorder,” they concluded. They added that further study is needed to confirm the model and to determine whether the use of age-at-onset subgroups could help to identify distinct genetic subgroups that revolve around age-specific genetic risk factors that contribute to the onset of the disorder.The study, “Age at Onset in Bipolar I Affective Disorder: Further Evidence for Three Subgroups,” is posted on the Web at http://ajp.psychiatryonline.org/cgi/content/full/160/5/999?. ▪ American Journal of Psychiatry 2003 160 999 ISSUES NewArchived

Psychiatric disorders in older women

With increased longevity and an aging ‘baby boomer‘ population, the numbers of women in older age groups in the United States will be increasing significantly over the coming years. Older women with schizophrenia and mood disorders that began in early adult life continue to need psychiatric treatment, although treatment considerations may require modification with age. In addition, late-onset depressive disorders are more common among older women than older men and may undermine physical and psychosocial well-being if inadequately treated. Late-onset schizophrenia and bipolar disorder are less common, but also affect older women more often than older men. Moreover, psychiatric concerns related to Alzheimer‘s disease and care giving are pertinent to this older population. Clinicians need to be knowledgeable about differences in epidemiology and clinical presentation that distinguish psychiatric disorders in older women from both men and from younger cohorts.

Further evidence for age of onset being an indicator for severity in bipolar disorder

Since the early report by Taylor and Abrams supported by Carlson et al. (1977). Moreover, McEl(1973) which suggested that age of onset might be roy et al. (1997) even found adolescent patients to used as a criterion to delineate subgroups in bipolar display a significantly lower rate of psychotic feaaffective disorder, several studies have tackled this tures than adult-onset bipolar patients. issue. However, consistent evidence for earlyand Further controversy surrounds the question of late-onset bipolar disorder representing two different whether age of onset might serve as a valid disphenotypes has not emerged so far. Studies by criminator between bipolar I and II disorder Ballenger et al. (1982), Rosen et al. (1983), Joyce (Peselow et al., 1982; Egeland et al., 1987; (1984), and Carlson et al. (2000) reported earlyMcMahon et al., 1994; Benazzi, 1999). In a very onset bipolar patients to suffer more often from recent approach, based on a large sample of consecu psychotic symptoms than patients with a late onset, tively recruited bipolar patients, Schurhoff et al. leading to a more severe clinical picture. These (2000) tested the hypothesis of whether the age of observations are partly supported by a study by onset in bipolar disorder might serve as an important McGlashan (1988), who found patients with adolesindicator for identifying more homogeneous clinical cent-onset mania to present with more psychotic subtypes. They compared clinical features, comorsymptoms and greater chronicity than adult-onset bidity and familial risk of 58 early-onset and 39 patients; however, the long-term outcome of the late-onset bipolar patients. For the early-onset group early-onset group was comparable or even better they observed a higher rate of psychotic sympthan that of the late-onset patients, a finding which is tomatology, elevated frequency of mixed episodes, greater comorbidity with panic disorder, and poorer prophylactic lithium responses. Furthermore, first*Corresponding author. Department of Psychiatry, University of degree relatives of early-onset patients also showed a Chicago, Jules F. Knapp Research Center, 924 East 57th Street, higher risk of affective disorder than relatives of Room R004, Chicago, IL 60637, USA. Tel.: 11-773-834-8920; patients with a late-onset bipolar illness. Thus, fax: 11-773-834-2970. E-mail address: schulze@uchicago.edu (T.G. Schulze). Schurhoff et al. (2000) concluded that an early age

Early and late onset bipolar disorders: two different forms of manic-depressive illness?

Background: Conflicting results in genetic studies of bipolar disorders may be due to the clinical and genetic heterogeneity of the disease. Age at onset of bipolar disorders may be a key indicator for identifying more homogeneous clinical subtypes. We tested whether early onset and late onset bipolar illness represent two different forms of bipolar illness in terms of clinical features, comorbidity and familial risk. Methods: Among a consecutively recruited sample of 210 bipolar patients, we compared early onset ( n=58) and late onset ( n=39) bipolar patients; the cut-off points were age at onset before 18 years and after 40 years for the two subgroups. The subgroups were compared by independent t tests and a contingency table by raw chi-square test. Morbid risk among first-degree relatives was measured by the survival analysis method. Results: The early onset group had the most severe form of bipolar disorder with more psychotic features ( P=0.03), more mixed episodes ( P=0.01), greater comorbidity with panic disorder ( P=0.01) and poorer prophylactic lithium response ( P=0.04). First degree relatives of early onset patients also had a higher risk of affective disorders ( P=0.0002), and exhibit the more severe phenotype, i.e bipolar disorder. Conclusion: Our data suggest that early and late onset bipolar disorders differ in clinical expression and familial risk and may therefore be considered to be different subforms of manic-depressive illness.

Comorbidity of attention deficit hyperactivity disorder with early- and late-onset bipolar disorder.

The relationship between attention deficit hyperactivity disorder (ADHD) and earlier age at onset of affective illness was examined in probands with a history of bipolar disorder. The authors assessed 56 adult bipolar subjects. Those with a history of childhood ADHD (N=8) were age and sex matched with bipolar subjects without a history of childhood ADHD (N=8). The age at onset of the first affective episode was lower for the subjects with bipolar disorder and a history of childhood ADHD (mean=12.1 years, SD=4.6) than for those without a history of childhood ADHD (mean=20. 0 years, SD=11.3). ADHD in children of bipolar probands might identify children at highest risk for development of bipolar disorder.

Assessment and treatment of bipolar disorder in the elderly.

The aetiology of late-onset bipolar disorder is heterogeneous because the disease is more likely to have a secondary (i.e. a medical disorder or medication-induced) cause in older than in younger patients. Elderly patients with bipolar disorder typically require lithium dosages that are 25 to 50% lower than those used in younger individuals. Information on the use of valproic acid (sodium valproate) in elderly patients with bipolar disorder is limited but encouraging. In contrast, there is virtually no information regarding the use of carbamazepine or other drugs in this patient group. Electroconvulsive therapy is well tolerated by older people and can be useful for these patients.

Age of first onset of bipolar disorder: Demographic, family history, and psychosocial correlates

The literature suggests that bipolar elders with early and late onset of the disorder present with different demographic, family history, and psychosocial profiles, which are less well characterized than those for elderly unipolar patients. In this cross-sectional clinical survey, we assessed subjects (n = 74) from the NIMH Clinical Research Center for the Study of Depression in Later Life at Duke University who had a consensus diagnosis of bipolar depression; the primary assessment instrument was the Duke Depression Evaluation Schedule. We found that bipolar subjects with later age of onset reported less family history of psychiatric problems, more comorbid vascular disease, and more instrumental and subjective social support. Stressful life events were more frequent among bipolar subjects with earlier age of depressive symptom onset. This study suggests that early-onset disorder may be characterized by a psychosocial component, whereas organic factors may be particularly important to late-onset bipolar disorder.

Age of first onset of bipolar disorder: Demographic, family history, and psychosocial correlates

The literature suggests that bipolar elders with early and late onset of the disorder present with different demographic, family history, and psychosocial profiles, which are less well characterized than those for elderly unipolar patients. In this cross-sectional clinical survey, we assessed subjects (n = 74) from the NIMH Clinical Research Center for the Study of Depression in Later Life at Duke University who had a consensus diagnosis of bipolar depression; the primary assessment instrument was the Duke Depression Evaluation Schedule. We found that bipolar subjects with later age of onset reported less family history of psychiatric problems, more comorbid vascular disease, and more instrumental and subjective social support. Stressful life events were more frequent among bipolar subjects with earlier age of depressive symptom onset. This study suggests that early-onset disorder may be characterized by a psychosocial component, whereas organic factors may be particularly important to late-onset bipolar disorder. Depression and Anxiety 7:76–82, 1998. © 1998 Wiley-Liss, Inc.

BIPOLAR MOOD DISORDERS IN THE ELDERLY

Age effects on early-onset bipolar illness may include changes in affective features and recovery. Age effects on the pharmacokinetics of lithium are clinically relevant. Average age at onset is relatively late among geriatric bipolars. Late-onset bipolar disorder is associated with lower rate of familial illness than early-onset cases and greater medical and neurologic comorbidity. The limited literature available points to the need for further studies of geriatric bipolar disorder. In such investigation, the distinction between age and age at onset effects provides a framework within which to enhance knowledge of psychopathology, to expand understanding of natural history and the impact of therapeutic interventions, and to study mechanisms.

Bipolar affective disorder and thrombocytopenia

AbstractThis report describes the case of a 62 year old man with late onset bipolar affective disorder whose mood swings were associated with episodes of thrombocytopenia. The inter-relationships between affective symptoms, the immune system and the hypothalamic pituitary axis are discussed.

Early- and late-onset bipolar affective disorder. A genetic study.

A group of 46 bipolar probands was divided equally into those with early (before age 30) and later onset. The only significant difference found was a higher morbidity risk for the relatives of the early-onset group. Slater's model for a polygenic transmission was found compatible with this group, but insufficient data prevented its application in the older-onset group. In all other respects, however, no significant differences were found. Age of onset of illness may be unhelpful in elucidating the genetic basis of affective disorder. Further progress will depend on the development of more sensitive mathematical models and the finding of specific genetic markers.