The Late-onset Bipolar Disorder: A Comparative Study

IntroductionBipolar disorders (BP) with late onset are underestimated by their frequency, their misleading presentations and therapeutic difficulties due to the high prevalence of somatic comorbidities.AimTo identify sociodemographic, clinical and therapeutic characteristics in subjects with a late-onset BP.Patients and methodsRetrospective and comparative study of 101 patients followed for a BP (12 patients with BP started after 50 years and 89 patients with BP started earlier) from 2009 to 2015, in the department of psychiatry of the University Hospital Farhat Hached, Sousse, Tunisia.ResultsThe mean age of subjects with late-onset TBP was 46.11 ± 12.85 years. Women were in the majority (65.3%). Ten patients had a novo mania, four patients had a late-onset mania and one patient had a secondary mania. Regarding the socio-demographic data, only the regular professional activity was more reported in the elderly (P = 0.017). Regarding clinical data, BP type 1 and secondary mania were more reported in elderly with (P = 0.050 and P = 0.000 respectively). Elderly had significantly fewer depressive episodes (P = 0.026), fewer hypomanic episodes (P = 0.000). The durations of the latest episodes and the last intervals were shorter in elderly (P = 0.045 and P = 0.000). Concerning therapeutic data, elderly had fewer hospitalizations (P = 0.045), required lower mean doses of lithium (P = 0.04) and greater mean doses of tricyclic antidepressants (P = 0.047).ConclusionIt is always necessary to look for an organic cause in manic syndrome in late-onset BP. Doses of lithium should be lower. However, doses of TAD should be higher.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Clinical diagnosis of 80 cases of dementia in a university hospital

Jornal Brasileiro de Psiquiatria ◽

10.1590/s0047-20852013000200007 ◽

2013 ◽

Vol 62 (2) ◽

pp. 139-143 ◽

Cited By ~ 1

Author(s):

Renata Teles Vieira ◽

Norami de Moura Barros ◽

Leonardo Caixeta ◽

Sergio Machado ◽

Adriana Cardoso Silva ◽

...

Keyword(s):

Demographic Data ◽

Lewy Body Dementia ◽

The Elderly ◽

Healthcare Services ◽

Epidemiological Studies ◽

University Hospital ◽

Functional Activities ◽

Considerable Impact ◽

The City ◽

State Examination

OBJECTIVE: This study aims to estimate the prevalence of dementia subtypes and to assess the socio-demographic data of patients attending the outpatient clinic of dementia at Hospital das Clínicas from January 2008 to December 2009, in the city of Goiânia-GO, Brazil. METHODS: Procedures provided for diagnosis included physical and neurological examination, laboratory tests, neuroimaging and DSM-IV. The functional capacity and level of cognitive deficit were assessed by Pfeffer Functional Activities Questionnaire (Pfeffer-FAQ) and Mini-Mental State Examination (MMSE), respectively. RESULTS: Eighty patients met the criteria for dementia. The mean age was 63.48 (± 16.85) years old, the schooling was 3.30 (± 3.59) years old, the MMSE was 13.89 (± 7.79) and Pfeffer 17.73 (± 9.76). The Vascular Dementia (VD; 17.5%) was the most frequent cause of dementia, followed by Lewy body dementia (LBD) and Alzheimer's disease (AD) (12.25%). CONCLUSION: Considering entire sample and only the elderly over 60 years, VD, AD and LBD are the most common subtypes observed at both groups. Further epidemiological studies are necessary to confirm such rates, which may have a considerable impact on the organization and planning of healthcare services in our country.

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Psychological and Physical Problems in Elderly People with Problems of Falls

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1112 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S659-S660

Author(s):

M. Mentis ◽

M. Gouva ◽

E. Antoniadou ◽

K. Mpourdoulis ◽

I. Kesoudidou ◽

...

Keyword(s):

Mental Health ◽

Physical Health ◽

Elderly People ◽

The Elderly ◽

Poor Mental Health ◽

University Hospital ◽

Psychological State ◽

Physical Damage ◽

The Difference ◽

Competing Interest

IntroductionFalls of the elderly to a degree been associated with poor mental health, poor social support and poor physical health.ObjectivesTo investigate the falls of elderly people in relation to their mental and physical healthy.AimsTo compare the effects of falls in the elderly in the areas of mental and physical health.MethodsThe current study used purposive sampling compromised from 48 people that visited the emergency department at the Patras University Hospital in 2016. The inclusion criterion for participation was age (> 65 years). Data was collected using WHO's questionnaire, the WHOQUOL-BREF. Finally, data was analyzed using the test t test for independent samples.ResultsThe sample constituted by 39.6% of male and 61.4% of female. The average age of the sample was M = 75.89 years. In relation to mental health, the average of the elderly with a history of falls found M = 57.26 (SD = ± 22.87), while the other was found M = 74.45 (SD = ± 15.81). The difference between the two groups was statistically significant (P < 0.05), while physical health although again the first group found to have a smaller average (M = 56.65, SD = ± 22.13) relative to the second group (M = 63.78, SD = ± 12.59) no statistical difference was observed.DiscussionsThese results demonstrates that falls beyond the physical damage that are immediately visible can as well create significant issues in the psychological state of the elderly exacerbating anxiety, fear and social isolation, which has been associated with depression event.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Sociodemographic and clinical profile in elderly suicide victims: 34 autopsy case studies

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1797 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s887-s887

Author(s):

S. Ellouze ◽

I. Baati ◽

W. Ben Amar ◽

D. Trigui ◽

W. Abbes ◽

...

Keyword(s):

Public Health ◽

Health Problem ◽

Suicide Risk ◽

Public Health Problem ◽

The Elderly ◽

University Hospital ◽

Major Public Health Problem ◽

Treatment Of Depression ◽

Competing Interest ◽

Elderly Suicide

IntroductionThe elderly suicide is a major public health problem that is gaining more and more ground, given the aging population problem. This has rarely been the subject of forensic studies in Tunisia.ObjectivesTo identify the sociodemographic and clinical characteristics of elderly suicide victims over 60 years and to determine what factors might increase suicide risk in this population.MethodsWe conducted a retrospective study on suicide victims aged 60 and over, autopsied in forensic medicine department of the Habib Bourguiba university hospital in Sfax (Tunisia), on a 10-year period (January 2006–December 2015).ResultsWe identified 34 cases with an average age of 66 years. The sex ratio was 2.77. Suicide victims were alone in 38.2% of cases. They were inactive professionally in 32.4% of cases. Almost half of them (44.1%) had a psychiatric history, 40% of depressed pace, 26.7% of bipolar disorder and 13.3% of schizophrenia.Three main factors were identified as precipitating the passage to suicidal act: family conflicts (26.5%), financial difficulties (11.8%) and loss of autonomy (5.9%).Suicide methods were hanging (50%), immolation and drug intoxication (11.8%), hit by train and poisoning (8.8%), jumping from height (5.9%) and drowning (2.9%). In 55.8% of cases, suicide took place at home.ConclusionElderly suicide seems to be a huge but largely preventable public health problem. Its prevention is essentially based on the identification of risk situations and the detection and treatment of depression: major suicide risk factor in this population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The impact of COVID-19 on orthopaedic trauma: A retrospective comparative study from a single university hospital in Italy

Orthopedic Reviews ◽

10.4081/or.2020.8941 ◽

2021 ◽

Vol 12 (4) ◽

Author(s):

Valerio Andreozzi ◽

Fabio Marzilli ◽

Mario Muselli ◽

Leonardo Previ ◽

Matteo Romano Cantagalli ◽

...

Keyword(s):

Comparative Study ◽

Demographic Data ◽

University Hospital ◽

Anatomical Location ◽

Injury Type ◽

Critical Issues ◽

Mode Of Transportation ◽

Retrospective Comparative Study ◽

Middle Aged Adults ◽

The Impact

The COVID-19 outbreak strongly affected Italy, putting a strain on the National healthcare system. Hospitals quickly reorganized the activity to cope with the emergency. This retrospective comparative study aimed to analyze the impact of the lockdown imposed in Italy during the COVID-19 outbreak on acute orthopedic trauma, in order to identify critical issues for improvement and future planning. We collected data on all the trauma admissions to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during the COVID- 19 pandemic lockdown in Italy, comparing them with the corresponding period in 2019. We reported demographic data; the characteristics of the injury, including the anatomical location, fracture, sprain, dislocation, contusion, laceration, whether the injury site was exposed or closed, where the injury occurred, and polytrauma. We also recorded the waiting time in the emergency room and mode of transportation. The study sample was composed of 1199 patients, 636 (53.04%) males and 563 (46.96%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during COVID-19 outbreak in 2020. The average age of the 2020 group was 51.9 ± 24.8 years, significantly higher than that of the 2019 group (41.4 ± 25.7) (p<0.0001). In particular, elderly patients (≥65 years) were the most commonly involved in the COVID-19 group, while in the pre- COVID-19 period they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 65.7% of cases in the 2020 group, and in 32.3% of patients in the 2019 group. Concerning the injury type, in both groups, the most common injury was a fracture (45.1% in 2019; 62.7% in 2020) (p<0.0001). The most injured anatomical location during COVID-19 lockdown was the hand (14.2%), while in the pre-COVID- 19 group the most frequent injury type was polytrauma (22.8%). Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly individuals remained stable, indicating that not all trauma presentations would necessarily decrease during such times.

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Suicidal ideation and organic diseases in acute female psychiatric patients

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.732 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s275-s275

Author(s):

P. Solano ◽

M. Ustulin ◽

R. Vecchio ◽

A. Rreshketa ◽

E. Pizzorno ◽

...

Keyword(s):

Suicidal Ideation ◽

Suicide Risk ◽

Psychiatric Patients ◽

Demographic Data ◽

The Elderly ◽

Physical Illness ◽

Psychiatric Clinic ◽

Medical Illness ◽

Chi Squared ◽

Competing Interest

IntroductionPhysical illness has been recognized as a major risk factor for suicidal behaviours, especially among females. A higher number of physical comorbidities has been associated with higher suicide- risk, thus having a greater burden among the elderly.Objectivesinvestigate this evidence to be able to estimate the load of physical illness on suicidality among psychiatric females of different age.AimsEvaluate the association between suicidal ideation, age, depression and physical comorbidities in a sample of acute females psychiatric in-patients.Methods81 psychiatric female in-patients were evaluated during their first day of hospitalization through MADRS, SSI and the presence of organic comorbidity has been collected together with demographic data. All the evaluations were carried out at the Psychiatric Clinic, University of Genova, Italy.ResultsMean age 48 (age–range value: 74, high variability). Pearson's Chi-squared test showed: significant association between SSI and MADRS (P = 0,027; α = 0,05); no association between SSI and age (P = 0,194; α=0,05); no association between SSI and presence medical illness (P = 0,132; α = 0,05); no association between SSI and number of medical illness (P = 0,186; α = 0,05).ConclusionsOur results show that the levels of suicidal ideation in psychiatric females are independent from age, presence and number of physical comorbidities. Suicidal ideation appears to be associated only with levels of depression. Our results challenge evidence from a large number of current studies and, if confirmed by further research, would lead to reconsider major suicide risk factors. Further research to investigate these associations on larger samples is needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Hippocampal/amygdala volumes in geriatric depression

Psychological Medicine ◽

10.1017/s0033291799008405 ◽

1999 ◽

Vol 29 (3) ◽

pp. 629-638 ◽

Cited By ~ 94

Author(s):

M. ASHTARI ◽

B. S. GREENWALD ◽

E. KRAMER-GINSBERG ◽

J. HU ◽

H. WU ◽

...

Keyword(s):

Major Depression ◽

Normal Control ◽

Late Onset ◽

Age At Onset ◽

Imaging Study ◽

The Elderly ◽

Clinical Population ◽

Control Subjects ◽

Depressed Patients ◽

Depressive Episodes

Background. The hippocampus, amygdala and related functional circuits have been implicated in the regulation of emotional expression and memory processes, which are affected in major depression. Several recent investigations have reported abnormalities in these structures in adult and elderly depressives.Methods. Elderly DSM-III-R unipolar depressives (N=40) and normal controls (N=46) participated in a magnetic resonance imaging study (1.0T). Brain images were obtained in the coronal plane. Using established anatomical guidelines for structure delineation, volumetric measurements of left and right hippocampus and anterior hippocampus/amygdala complex were completed under blinded conditions using a semi-automated computer mensuration system, with patients and controls in random order.Results. Medial temporal volumes did not significantly distinguish either elderly depressed and age-similar normal control subjects, or late onset and early onset depressed patients (ANCOVA). Major overlap of measured volumes existed between patient and control groups. In depressives, hippocampal volumes significantly correlated with age, and cognitive and depression ratings, but not with number of prior depressive episodes or age-at-onset of first depression.Conclusions. Hippocampal volumes do not discriminate a typical clinical population of elderly depressed patients from age-similar normal control subjects. If hippocampal dysfunction contributes to a diagnosis of syndromal depression in the elderly, such dysfunction does not appear to be regularly reflected in structural abnormalities captured by volumetric measurement as conducted. On the other hand, relationships between hippocampal volumes and clinical phenomena in depressives, but not controls, suggest potentially meaningful interactions between hippocampal structure and the expression of major depression in the elderly.

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Liaison psychiatry–characterization of inpatients with psychiatric pathology in the infectiology service

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.591 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S489-S489

Author(s):

T. Carvalhao

Keyword(s):

Antiretroviral Therapy ◽

Hiv Infection ◽

Social Life ◽

Direct Action ◽

Demographic Data ◽

University Hospital ◽

Emotional Impact ◽

Liaison Psychiatry ◽

Competing Interest ◽

The Individual

IntroductionThe interface of the Liaison Psychiatry with Infectiology is fundamental for the continuous and specialized support of these patients. Prevalent psychiatric records are known in the HIV infection, such as anxiety, depression and abuse and/or addiction to substances. There are also different neuropsychiatric situations associated with this infection owing, namely, to the HIV direct action on the central nervous system, to the adverse effect of the antiretroviral therapy and to the resurgence of existing prior pathology.ObjectiveThe author intends to characterize the population evaluated in the Liaison psychiatry in the Coimbra university hospital with respect to inpatients of the Infectiology Service in a central hospital in order to optimize resources and better adjust interventions made.Methods and resultsThe quantitative retrospective study was carried out between May 2015 and May 2016, with a duration of one year, in the infectiology service of the Coimbra university hospital.Observation and evaluation of the inpatient of the infectiology service having in view the sample characterization in relation to demographic data, nature of the request, antiretroviral therapy, psychiatric diagnosis, type of intervention and follow-up. The quantitative data were subject to statistical analysis.ConclusionThe prevalence of the psychiatric disorders associated with HIV infection is high and with great emotional impact and implications in the personal, sexual, occupational and social life of the individual. The diagnosis and treatment of the psychiatric comorbidity is determinant in the patients’ evolution, both in reducing suffering associated with experience of HIV infection and in its implications.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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The late-onset bipolar disease: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1171 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S335-S335

Author(s):

A. Lopes ◽

P. Sales

Keyword(s):

Bipolar Disorder ◽

Late Onset ◽

Neurological Diseases ◽

Balance Sheet ◽

Manic Episode ◽

The Elderly ◽

Elderly Subjects ◽

Psychomotor Agitation ◽

The Usa ◽

Competing Interest

The prevalence of bipolar disorder after 65 years is 0.1 to 0.4%. Mania represents 4.6% to 18.5% of all psychiatric admissions in geriatrics in the USA. It has some specificity in terms of clinical presentation, evolution, prognosis and treatment.We report the case of a patient who presented a first manic episode after 65 years. E.H, AP, 67 years old, single, without personal and familial psychiatric history, addressed to psychiatric emergencies for psychomotor agitation and euphoric mood. He presented two months ago a manic access with almost total insomnia, euphoria, psychomotor agitation and delusions of grandeur. The balance sheet reveals no incorrections (blood count, thyroid balance, serology: TPHA, VDRL, hepatitis B and C, HIV). The cerebral CT was normal. The patient has been received a quetiapine 200 mg/day, olanxapine 10 mg/day and valproate 1000 mg/day. The evolution after three weeks was favorable.The late-onset bipolar disorder is characterized by: a less intense euphoria, replaced by anger and irritability, a more elements of persecution, disinhibiting and impulsivity. Respecting to that, this case is an exception. The most common confounding symptoms and behavioral disorders. A higher frequency of neurological diseases is noted in elderly subjects with a bipolar disorder and, so, a neuropsychiatric rigorous evaluation is fundamental to exclude the possibility of an organic pathology for the manic access. The prescription of psychotropic drugs in the elderly must be under monitoring.Disclosure of interest The authors have not supplied their declaration of competing interest.

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508 - LATE ONSET BIPOLAR DISORDER: CASE REPORT AND LITERATURE REVIEW

International Psychogeriatrics ◽

10.1017/s1041610221002039 ◽

2021 ◽

Vol 33 (S1) ◽

pp. 60-60

Author(s):

Joana Regala ◽

João Reis

Keyword(s):

Bipolar Disorder ◽

Case Report ◽

Electroconvulsive Therapy ◽

Late Onset ◽

Diffuse Axonal Injury ◽

First Episode ◽

Triggering Factors ◽

History Of ◽

Secondary Mania ◽

Depressive Episodes

Background:Late-onset bipolar disorder (LOBD) remains an incompletely understood nosological entity, in reason of its complexity and the paucity of research in this issue. It is not yet clear whether LOBD is a “phenocopy” of the classic early-onset bipolar disorder (EOBD), sharing symptoms but having a different aetiology, or whether both have a common underlying vulnerability that interacts with age-specific triggering factors. Some authors have proposed that LOBD is a heterogeneous entity, comprising secondary mania (including organic brain disease), bipolarity in the context of dementia-like processes (BD type VI), and LOBD as expression of a lower vulnerability to bipolarity.Case Report:Female patient with previous medical history of hypertension and dyslipidaemia, and psychiatric history of recurrent severe depressive episodes since early age, with melancholic and psychotic features, had a first hypomanic episode at 76 years-old, under treatment with tricyclic antidepressant and electroconvulsive therapy. Meanwhile, she suffered a traumatic brain injury (TBI) complicated with subdural and subarachnoid hematoma, as well as intraventricular haemorrhage, which is an indirect sign of diffuse axonal injury (DAI). Later, at 79 years-old, she presented a mixed episode characterized by racing thoughts, flight of ideas, non-systematized persecutory and ruin delusions, hyposomnia, and ultradian alternation between dysphoric and depressive mood, psychomotor agitation and retardation, emotional lability, hypersyntonic contact and hostility. Medical conditions that could account for secondary mania were ruled out. This clinical picture subsided within few weeks under treatment with olanzapine and electroconvulsive therapy. After recovery memory deficits were noticed.Concluding remarks:This case illustrates a “latent” BD, in a patient with previous recurrent depressive disorder, manifesting the first episode of mania in late life. Several triggering factors may have contributed to this longitudinal evolution, lowering the threshold to manifest mania, namely cerebrovascular risk factors, a possible underlying degenerative process and DAI secondary to TBI, which through structural dysconnectivity also contributes to cognitive dysfunction. The deleterious effect of recurrent and severe depressive episodes on cognition is well documented. The question of whether some forms of LOBD could constitute a special risk factor for developing dementia deserves further investigation.

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Late Onset Bipolar Disorder: Clinical Characterization

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1900 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S116-S116

Author(s):

J. Gomes ◽

A. Sousa ◽

H. Afonso ◽

G. Lima

Keyword(s):

Bipolar Disorder ◽

Social Impact ◽

Late Onset ◽

Bipolar Disease ◽

Search Terms ◽

Competing Interest ◽

Disease Variant ◽

Secondary Mania ◽

Severe Psychopathology

IntroductionBipolar disease is a chronic mental illness with a deep personal and social impact. Alongside with the considerable progress in understanding and treating bipolar disorder, and despite the growing interest in geriatric psychiatry, late onset bipolar disorder has been relatively little studied so far.ObjectivesTo review the literature regarding the epidemiology, characteristics and clinical implications of late onset bipolar disorder.MethodologyA literature review was performed by searching articles in Pubmed, using the following search terms: “late onset bipolar disorder” and “elderly bipolar disorder”. All literature in English published in the last 15 years was examined and 11 articles were selected.ResultsAlthough the frequency of bipolar disorder type 1 or 2 decrease with age, approximately 6 to 8% of the new cases of bipolar disorder develop in people over 60 years of age. Clinically, late-onset bipolar disorder appears to be associated with a better level of pre-morbid functioning, a less severe psychopathology as well as a smaller family burden of psychiatric illness. The term “secondary mania” postulated by Krauthmamer Klerman has been used to describe a bipolar disease variant associated with a variety of organic factors that may be responsible for this late-onset disease.ConclusionsLate onset bipolar disorder is probably a different diagnostic than the entity that occurs in younger patients, since it presents with a different clinical presentation. It is a heterogeneous disease with a complex etiology that still needs more research.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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