Atypical features of bipolarity in old age

doi:10.1017/CBO9780511544019.012

11 - Atypical features of bipolarity in old age

Published online by Cambridge University Press: 10 August 2009

Kenneth I. Shulman

Edited by

Andreas Marneros and

Frederick Goodwin

Show author details

Kenneth I. Shulman: Affiliation:
University of Toronto Sunnybrook and Women's, Toronto, Ontario Canada
Andreas Marneros: Affiliation:
Martin Luther-Universität Halle-Wittenburg, Germany
Frederick Goodwin: Affiliation:
George Washington University, Washington DC

Book contents

Get access

Summary

Introduction

Studying an elderly cohort confers several special advantages compared to younger or mixed-age populations. In the first instance, one has available a lifelong clinical course that has already unfolded. This allows for tracking of age of onset and describing long-term clinical patterns in a way that is much more practical than extensive prospective studies of younger patients. Second, genetic patterns of inheritance can be more fully explored as the exposure in first-degree relatives, especially children and siblings, will be much longer than in studies of younger probands. Third, an elderly cohort offers the opportunity to study lesions of the brain, thus casting more light on localization and pathogenesis, which can be extrapolated back to potential neurophysiological patterns in younger bipolars. Finally, outcome studies of the elderly can reveal differential rates of mortality and psychosocial vulnerability which can be compared to controls, other mood disorders, and neuropsychiatric conditions of late life.

Atypical features

These special aspects of study in the elderly result in features of bipolarity which are quite different from the usual cohorts of bipolar disorder whose mean age of onset is in the early 20s (Weissman et al., 1991). Not surprisingly, atypical features described in this chapter will include:

late age of onset
prolonged latency from first depression to first mania
high prevalence of neurologic comorbidity
presence of cognitive impairment
poor outcome characterized by increased mortality and finally increased nosologic confusion related to the presence of neurologic comorbidity and the similarity of secondary mania to other neurological conditions with disinhibition syndromes (Shulman, 1997)

Keywords

bipolarity cognitive impairment depression mortality therapeutic range neurologic comorbidity old age

Type: Chapter
Information: Bipolar Disorders
Mixed States, Rapid Cycling and Atypical Forms
, pp. 252 - 262

DOI: https://doi.org/10.1017/CBO9780511544019.012 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S., Meyers, B. S., Young, R. C., et al. (1993). The course of geriatric depression with ‘reversible dementia’: a controlled study. Am. J. Psychiatry, 150, 1693–9.Google Scholar

Alexopoulos, G. S., Meyers, B. S., Young, R. C., et al. (1997). Vascular depression hypothesis. Arch. Gen. Psychiatry, 54, 915–22.Google Scholar

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. (DSM-IV). Washington, DC: APA.

Angst, J. (1978). Verlauf endogener Psychosen. In Aktuelle Neurologie und Psychiatrie, ed. Finke, J. and Tolle, R., pp. 203–10. Berlin: Springer.

Berrios, G. E. and Bakshi, N. (1991). Manic and depressive symptoms in the elderly: their relationships to treatment outcome, cognition and motor symptoms. Psychopathology, 24, 31–8.Google Scholar

Braun, C. M. J., Larocque, C., Daigneault, S., et al. (1999). Mania, pseudomania, depression, and pseudodepression resulting from focal unilateral cortical lesions. Neuropsychiatry, Neuropsychol. Behav. Neurol., 12, 35–51.Google Scholar

Broadhead, J. and Jacoby, R. (1990). Mania in old age: a first prospective study. Int. J. Geriatr. Psychiatry, 5, 215.Google Scholar

Chen, S. T., Altshuler, L. L., and Spar, J. E. (1998). Bipolar disorder in late life: a review. J. Geriatr. Psychiatry Neurol., 11, 29–35.Google Scholar

Dhingra, U. and Rabins, P. V (1991). Mania in the elderly: a five-to-seven-year follow-up. J. Am. Geriatr. Soc., 39, 582–3.Google Scholar

Dinan, T. (2002). Lithium in bipolar mood disorder. Br. Med. J., 324, 989–90.Google Scholar

Fazekas, F., Niederkorn, K., Schmidt, R.et al. (1988). White matter signal abnormalities in normal individuals: correlation with carotid ultrasonography, cerebral blood flow measurement and cerebrovascular risk factors. Stroke, 19, 1285–8.Google Scholar

Fujikawa, T., Yamawaki, S., and Touhouda, Y. (1995). Silent cerebral infarctions in patients with late-onset mania. Stroke, 26, 946–9.Google Scholar

Goodwin, F. K. and Jamison, K. R. (1984). The natural course of manic-depressive illness. In Neurobiology of Mood Disorders, ed. Post, R. M. and Ballenger, J. C., pp. 20–37. Edinburgh: Williams and Wilkins.

Goodwin, F. K. and Jamison, K. R. (1990). Manic-Depressive Illness. New York: Oxford University Press.

Hardy, B. G., Shulman, K. I., and Zucchero, C. (1997). Gradual discontinuation of lithium argumentation in elderly patients with unipolar depression. J. Clin. Psychopharmacol., 17, 22–6.Google Scholar

Hays, J. C., Krishnan, K. R. R., George, L. K., et al. (1998). Age of first onset of bipolar disorder: demographic, family history, and psychosocial correlates. Depress. Anxiety, 7, 76–82.Google Scholar

Jeste, D. V., Lacro, J. P., Bailey, A., et al. (1999). Lower incidence of tardive dyskinesia in risperidone compared with haloperidol in older patients. J. Am. Geriatr. Soc., 47, 716–19.Google Scholar

Kessler, R. C., Rubinow, D. R., Holmes, C., et al. (1997). The epidemiology of DSM-III-R bipolar I disorder in a general population survey. Psychol. Med., 27, 1079–89.Google Scholar

Kobayashi, S., Okada, K., and Yamashita, K. (1991). Incidence of silent lacunar lesions in normal adults and its relation to cerebral blood flow and risk factors. Stroke, 22, 1379–83.Google Scholar

Krauthammer, C. and Klerman, G. L. (1978). Secondary mania: manic syndromes associated with antecedent physical illness or drugs. Arch. Gen. Psychiatry, 35, 1333–9.Google Scholar

Krishnan, K. R. R. and McDonald, W. M. (1995). Arteriosclerotic depression. Med. Hypotheses, 44, 111–15.Google Scholar

McDonald, W. M., Tupler, L. A., Marsteller, F. A., et al. (1999). Hyperintense lesions on magnetic resonance images in bipolar disorder. Biol. Psychiatry, 45, 965–71.Google Scholar

Murray, N., Hopwood, S., Balfour, D. J. K., et al. (1983). The influence of age on lithium efficacy and side effects in out-patients. Psychol. Med., 13, 53–60.Google Scholar

Petterson, U. (1977). Manic-depressive illness. A clinical, social and genetic study. Acta Psychiatr. Scand., 269, 1–93.Google Scholar

Rasanan, P., Tiihonen, J., and Hakko, H. (1998). The incidence and onset-age of hospitalised bipolar affective disorder in Finland. J. Affect. Disord., 48, 63–8.Google Scholar

Roose, S. P., Bone, S., Haidorfer, C., et al. (1979). Lithium treatment in older patients. Am. J. Psychiatry, 136, 843–4.Google Scholar

Shulman, K. I. (1997). Disinhibition syndromes, secondary mania and bipolar disorder in old age. J. Affect. Disord., 46, 175–82.Google Scholar

Shulman, K. I. and Herrmann, N. (1999). The nature and management of mania in old age. Psychiatr. Clin. North Am., 22, 649–65.Google Scholar

Shulman, K. I. and Herrmann, N. (2000). Bipolar disorder in old age. In Bipolar Disorders: 100 Years after Manic-Depressive Insanity, ed. Marneros, A. and Angst, J., pp. 153–74. Dordrecht: Kluwer Academic Publishers.

Shulman, K. I. and Herrmann, N. (2002). Manic syndromes in old age. In Psychiatry in the Elderly, 3rd edn, ed. Jacoby, R. and Oppenheimer, C., pp. 683–95. Oxford: Oxford University Press.

Shulman, K. and Post, F. (1980). Bipolar affective disorder in old age. Br. J. Psychiatry, 136, 26–32.Google Scholar

Shulman, K. I. and Singh, A. (1999). Comorbidity and bipolar disorder in old age. In Comorbidity in Affective Disorders, ed. Tohen, M., pp. 249–61. New York: Marcel Dekker.

Shulman, K. I. and Tohen, M. (1994). Unipolar mania reconsidered: evidence from an elderly cohort. Br. J. Psychiatry, 164, 547–9.Google Scholar

Shulman, K. I., MacKenzie, S., and Hardy, B. (1987). The clinical use of lithium carbonate in old age. J. Progr. Neuro-Psychopharmacol. Biol. Psychiatry, 11, 159–64.Google Scholar

Shulman, K. I., Tohen, M., Satlin, A., Mallya, G., and Kalunian, D. (1992). Mania compared with unipolar depression in old age. Am. J. Psychiatry, 142, 341–5.Google Scholar

Shulman, R. W., Singh, A., and Shulman, K. I. (1997). Treatment of elderly institutionalised bipolar patients with clozapine. Psychopharmacol. Bull., 33, 113–18.Google Scholar

Sibisi, C. D. (1990). Sex differences in the age of onset of bipolar affective illness. Br. J. Psychiatry, 156, 842–5.Google Scholar

Smith, R. E. and Helms, P. M. (1982). Adverse effects of lithium therapy in the acutely ill elderly patient. J. Clin. Psychiatry, 43, 94–9.Google Scholar

Snowdon, J. (1991). A retrospective case-note study of bipolar disorder in old age. Br. J. Psychiatry, 158, 484–90.Google Scholar

Spicer, C. C., Hare, E. H., and Slater, E. (1973). Neurotic and psychotic forms of depressive illness: evidence from age-incidence in a national sample. Br. J. Psychiatry, 123, 535–41.Google Scholar

Starkstein, S. E., Mayberg, H. S., Berthier, M. L., et al. (1990). Mania after brain injury: neuroradiological and metabolic findings. Ann. Neurol., 27, 652–9.Google Scholar

Steffens, D. C. and Krishnan, K. R. R. (1998). Structural neuroimaging and mood disorders. Recent findings, implications for classification, and future directions. Biol. Psychiatry, 43, 705–12.Google Scholar

Stone, K. (1989). Mania in the elderly. Br. J. Psychiatry, 155, 220–4.Google Scholar

Strakowski, S. M., McElroy, S., Keck, P., et al. (1994). The co-occurrence of mania with medical and other psychiatric disorders. J. Psychiatry Med., 24, 305–28.Google Scholar

Taragano, F. E., Allegri, R., Vicario, A., et al. (2001). A double blind, randomized clinical trial assessing the efficacy and safety of augmenting standard antidepressant therapy with nimodipine in the treatment of ‘vascular depression’. Int. J. Geriatr. Psychiatry, 16, 254–60.Google Scholar

Tohen, M., Waternaux, C. M., and Tsuang, M. T. (1990). Outcome in mania: a four year prospective follow-up study utilising survival analysis. Arch. Gen. Psychiatry, 47, 1106–11.Google Scholar

Tohen, M., Shulman, K. I., and Satlin, A. (1994). First-episode mania in late life. Am. J. Psychiatry, 151, 130–2.Google Scholar

Tohen, M., Snager, T. M., McElroy, S. L., et al. (1999). Olanzapine versus placebo in the treatment of acute mania. Am. J. Psychiatry, 156, 702–9.Google Scholar

Verdoux, H. and Bourgeois, M. (1995). Manies secondaires à des pathologies organiques cerebrales. Ann. Med. Psychology, 153, 161–8.Google Scholar

Weissman, M. M., Bruce, M. L., Leak, P. J., et al. (1991). Affective disorders. In Psychiatric Disorders in America. The Epidemiologic Catchment Area Study, ed. Robins, L. N. and Regier, D. A., p. 53. New York: Free Press.

Wylie, M. E., Mulsant, B. H., Pollock, B. G., et al. (1999). Age at onset in geriatric bipolar disorder. Am. J. Geriatr. Psychiatry, 7, 77–83.Google Scholar

Young, R. C. and Klerman, G. L. (1992). Mania in late life: focus on age at onset. Am. J. Psychiatry, 149, 867–76.Google Scholar

Young, R. C., Nambudiri, D. E., Jain, H., et al. (1999). Brain computed tomography in geriatric manic disorder. Biol. Psychiatry, 45, 1063–5.Google Scholar

Book contents

11 - Atypical features of bipolarity in old age

Summary

Keywords

Access options

References

Save book to Kindle

Save book to Dropbox

Save book to Google Drive