Early and Late Onset Bipolar Disorders in Older Adults

2017 ◽  
Vol 41 (S1) ◽  
pp. S211-S211
Author(s):  
N. Smaoui ◽  
L. Zouari ◽  
N. Charfi ◽  
M. Maâlej-Bouali ◽  
N. Zouari ◽  
...  
Keyword(s):  
Older Adults ◽  
Bipolar Disorder ◽  
Early Onset ◽  
Age Of Onset ◽  
Late Onset ◽  
Age At Onset ◽  
Bipolar Disorders ◽  
Medical Diagnoses ◽  
The Mean ◽  
Bipolar Patients

IntroductionAge of onset of illness may be useful in explaining the heterogeneity among older bipolar patients.ObjectiveTo examine the relationship of age of onset with clinical, demographic and behavioral variables, in older patients with bipolar disorder.MethodsThis was a cross-sectional, descriptive and analytical study, including 24 patients suffering from bipolar disorders, aged 65 years or more and followed-up in outpatient psychiatry unit at Hedi Chaker university hospital in Sfax in Tunisia. We used a standardized questionnaire including socio-demographic, behavioral and clinical data. Age of onset was split at age 40 years into early-onset (< 40 years; n = 12) and late-onset (≥ 40 years; n = 12) groups.ResultsThe mean age for the entire sample was 68.95 years. The mean age of onset was 39.95 years. The majority (60%) of patients were diagnosed with bipolar I. Few meaningful differences emerged between early-onset and late-onset groups, except that tobacco use was significantly higher in the late-onset group (66.6% vs. 16.6%; P = 0.027). No significant differences between the early-onset and late-onset groups were seen on demographic variables, family history and number of medical diagnoses or presence of psychotic features.ConclusionOur study found few meaningful behavioral differences between early versus late age at onset in older adults with bipolar disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Quality of life in bipolar disorders compared to schizophrenia

2011 ◽  
Vol 26 (S2) ◽  
pp. 231-231
Author(s):  
L. Zouari ◽  
I. Abida ◽  
M. Walha ◽  
J. Masmoudi ◽  
J. Ben Thabet ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bipolar Disorder ◽  
Short Form ◽  
Age At Onset ◽  
Bipolar Disorders ◽  
Subscale Score ◽  
Sf 36 ◽  
Schizophrenic Patients ◽  
Bipolar Patients

IntroductionThe classic opinion of a favorable prognosis of bipolar disorders, compared to schizophrenia, is refuted by modern conceptions.ObjectivesThe aim of this study was to assess the quality of life (QOL) in bipolar patients compared to schizophrenic patients’, and to identify clinical and sociodemographic variables statistically associated to a poor QOL in bipolar disorder patients.MethodsOne hundred and twenty outpatients, 50 with bipolar disorder and 70 with schizophrenia, according to DSM-IV-TR criteria, were included in the study. The QOL has been assessed, in all patients, using the «36 item Short-Form Health Survey» (SF-36).ResultsThirty-six percent of the bipolar patients had a poor QOL, versus 37% among the schizophrenic patients. The bipolar patients had the score of the standardized vitality subscale significantly lower than schizophrenic patients’ (p = 0.036); the latter had the standardized general health subscale score significantly lower (p = 0.03). There were no other statistically significant differences. The multivariate analyses showed three variables significantly correlated to a poor QOL in bipolar patients: age at the time of the study ≥ 40 years (p = 0.01), professional irregularity or inactivity (p = 0.005), age at onset ≥ 25 years (p = 0.004).ConclusionOur survey of the QOL in bipolar patients showed that it did not differ globally from the schizophrenic patients’, with the SF-36 scale. Results reported in the literature are not in agreement. Further longitudinal studies on several months, with other assessments, would permit to verify the validity of our results.

Bipolar Disorder: Similarities and Differences Between Patients With Illness Onset Before and After 65 Years of Age

2002 ◽  
Vol 14 (3) ◽  
pp. 311-322 ◽  
Author(s):  
Osvaldo P. Almeida ◽  
Stephen Fenner
Keyword(s):  
Bipolar Disorder ◽  
Health Services ◽  
Mental Disorder ◽  
Western Australia ◽  
Early Onset ◽  
Age Of Onset ◽  
Late Onset ◽  
Psychiatric Services ◽  
Organic Mental Disorder ◽  
First Contact

Background: Recent reports have suggested that bipolar disorder beginning in late life is strongly associated with organic brain disease whereas early-onset cases are more likely to be associated with a family history of mood disorder. It is not yet clear whether late-onset bipolar disorder is therefore a “phenocopy” of the classic early-onset disorder, sharing symptoms but having a different etiology, or whether people with early- and late-onset bipolar disorder have a common underlying vulnerability that interacts with age-specific triggering factors. Aim: The present study examines the administrative records of patients treated for bipolar disorder, to establish whether differences between early- and late-onset cases might be consistent with their having distinct etiological processes. Methods: We used a file containing administrative data for all patients with a diagnosis of bipolar disorder who were in contact with the health services of Western Australia between 1980 and 1998. For each contact with psychiatric services, the file provided the patient's age, gender, marital status, educational achievement, employment, ethnic origin, postcode of residence, primary and secondary diagnoses, and the duration of the (administrative) episode. Subjects were designated “late-onset” when their first contact with psychiatric services occurred at or after 65 years of age. Results: Between 1980 and 1998 there were 33,004 service contacts involving 6,182 individuals whose primary or secondary clinical diagnosis was bipolar disorder. This indicates that the prevalence of bipolar disorder in Western Australia is approximately 0.4%. Most patients had an onset of illness between 15 and 45 years of age, but 492 patients (8%) were aged 65 years or over at the time of first contact with mental health services. We observed that the relative frequency of late-onset bipolar disorder increased between 1980 and 1998 (1% to 11%). There was an excess of women in our cohort (3:2), but no difference in the age of onset between males and females. Early onset was associated with a subsequently lower socioeconomic status, aboriginal ethnicity, and a higher frequency of mixed affective episodes, other mood disorders, schizophrenia, and schizoaffective disorder. Patients with late-onset bipolar disorder were more likely to have a diagnosis of organic mental disorder recorded (2.8% vs. 1.2%). There was no evidence of a bimodal pattern of age-specific incidence. Conclusion: The observed differences between early- and late-onset bipolar disorders are small and most likely attributable to differences in the duration of illness. Only a small proportion of patients with bipolar disorder were ever diagnosed with an organic mental disorder, which suggests that the reported association between late onset of illness and organic factors may be of limited clinical relevance.

scholarly journals The Use of Cannabis as a Predictor of Early Onset of Bipolar Disorder and Suicide Attempts

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Rafaela Torres Portugal Leite ◽  
Sarah de Oliveira Nogueira ◽  
João Paulo Rodrigues do Nascimento ◽  
Laisa Soares de Lima ◽  
Taís Bastos da Nóbrega ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Early Onset ◽  
Suicide Attempts ◽  
Age At Onset ◽  
Prognostic Significance ◽  
Manic Episode ◽  
Cannabis Use ◽  
Pubmed Database ◽  
Increased Risk ◽  
Bipolar Patients

Introduction. Bipolar disorder (BD) implies risk of suicide. The age at onset (AAO) of BD carries prognostic significance. Substance abuse may precede the onset of BD and cannabis is the most common illicit drug used. The main goal of this study is to review the association of cannabis use as a risk factor for early onset of BD and for suicide attempts.Materials and Methods. PubMed database was searched for articles using key words “bipolar disorder,” “suicide attempts,” “cannabis,” “marijuana,” “early age at onset,” and “early onset.”Results. The following percentages in bipolar patients were found: suicide attempts 3.6–42%; suicide attempts and substance use 5–60%; suicide attempts and cannabis use 15–42%. An early AAO was associated with cannabis misuse. The mean age of the first manic episode in individuals with and without BD and cannabis use disorder (CUD) was 19.5 and 25.1 years, respectively. The first depressive episode was at 18.5 and 24.4 years, respectively. Individuals misusing cannabis showed increased risk of suicide.Discussion. Cannabis use is associated with increased risk of suicide attempts and with early AAO. However, the effect of cannabis at the AAO and suicide attempts is not clear.

Impact of Age at Onset on the Long-term Course of Bipolar Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S13-S14
Author(s):  
R. Kupka
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempts ◽  
Age Of Onset ◽  
Late Onset ◽  
Past History ◽  
Age At Onset ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Impact

IntroductionBipolar disorder (BD) typically starts in adolescence or young adulthood (early-onset; EO-BD), which may have different backgrounds and consequences than late-onset (LO) BD. There are controversies over pre-pubertal age of onset (AoO).ObjectivesTo give an overview of the various concepts of AoO in BD, the impact of AoO on subsequent illness course, and findings of the Stanley Foundation Bipolar Network (SFBN) with relationship to AoO.Methodsliterature review and additional analyses of SFBN database.ResultsBD usually begins with a depressive episode. SFBN-data reveal that an earlier AoO is associated with a less favourable prospective illness course (more depression, mood instability and rapid cycling), longer delay to first treatment, past history of suicide attempts, being abused in childhood abuse, more psychiatric and medical comorbidities. Comparison of the US sample with the European sample of SFBN showed an earlier onset in US patients.Conclusionand early AoF of BD is associated with a poorer long-term outcome, despite adequate current treatment.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals Ala97Ser transthyretin amyloidosis-associated polyneuropathy, clinical and neurophysiological profiles in a Thai cohort

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nath Pasutharnchat ◽  
Chamaiporn Taychargumpoo ◽  
Yongkasem Vorasettakarnkij ◽  
Jakkrit Amornvit
Keyword(s):  
Early Onset ◽  
Age Of Onset ◽  
Late Onset ◽  
Detection Threshold ◽  
Han Chinese ◽  
Motor Neuropathy ◽  
Transthyretin Amyloidosis ◽  
Initial Symptoms ◽  
Chinese Descent ◽  
The Mean

Abstract Background Ala97Ser transthyretin amyloidosis-associated polyneuropathy (ATTRA97S-PN) is a rare form of inherited polyneuropathy, usually manifesting with late-onset (> 50) progressive polyneuropathy. This mutation is mostly prevalent in Taiwanese and Han-Chinese individuals. The aim of this study was to describe the clinical and comprehensive neurophysiological profiles of ATTRA97S-PN in Thai patients. Methods The clinical profiles and serial neurophysiologic studies (nerve conduction study (NCS), quantitative sensory test (QST), and comprehensive autonomic function test (AFT)) of symptomatic ATTRA97S-PN patients who had been followed-up at King Chulalongkorn Memorial Hospital during 2010–2020 were retrospectively reviewed. Results Nine symptomatic patients (55.6 % were male) from four unrelated families were included. All were Thais of mixed Thai Chinese descent. The mean age of onset was 48.3 (32–60) years. The mean age at diagnosis was 54.8 (33–66) years. Three patients developed early-onset (< 40y) polyneuropathy. The mean Neuropathy Impairment Score was 41.33 (10–92) at diagnosis. Sensory (9/9) and autonomic (9/9) neuropathies were more frequent than motor neuropathy (5/9), which appeared in the late stage of disease. Hypoesthesia in the feet, and gastrointestinal autonomic symptoms were frequently reported as the initial symptoms. The course of neuropathy progressed over years to decades. The worsening of neuropathy tended to progress faster once motor nerves were affected in both clinical and neurophysiological aspects. Concurrent cardiac amyloidosis was found in 6/9 patients. NCS showed length-dependent sensorimotor axonal polyneuropathy in 5/9 patients, and median neuropathy at the wrist (mostly bilateral) in 7/9 patients. QST showed abnormalities in the vibratory detection threshold, the cold detection threshold and the heat pain sensation in 8/9, 8/9 and 7/7 tested patients, respectively. AFT results were abnormal in all. The mean composite autonomic severity score was 5 (3–9). Conclusions This clinical study is the first of ATTRA97S-PN in Thai patients. The mixed polyneuropathy-cardiopathy phenotype was the most common manifestation. In this cohort, the age of onset was lower, and the course of neuropathy was relatively longer, than that in previous studies. Some patients may develop early-onset polyneuropathy. This mutation has not yet been documented in any population other than Han Chinese-related populations, probably suggesting a founder effect. Further studies are warranted.

scholarly journals Pink1 type of Early Onset Parkinson’s disease(EOPD)in Sudanese patients, 2018

2019 ◽  
Author(s):  
Etedal Ahmed A. Ibrahim ◽  
Samer Abdalaziz Albasher
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Family History ◽  
Early Onset ◽  
Age Of Onset ◽  
Age At Onset ◽  
Age Group ◽  
Pink1 Gene ◽  
The Mean ◽  
Early Onset Parkinson’S Disease

Background: Parkinson’sDisease (PD) is a neurodegenerative disorder affecting the motor system. It is a chronic progressive disorder which leads to long standing disability. Objective: To study the Presentations and pink1 gene in young Sudanese patients with Parkinson’s disease . Material and Methods: A prospective study was conducted among 31 PD patients at the National center for Neurological Science (NCNS) at Khartoum state. A structured questionnaire was used for data collection. Consisted of personal data, clinical presentations and investigations. RT-PCR technique using G-spin™ kit.  PINK1 gene was detected in most of the samples it was strongly positive. The data was analyzed using SPSS version 21. Results:. The majority of them 19 (61%) were located in age group 41 – 50 years; the mean age of onset was 33.4+_12 yrs.  19 (61%) of the subjects were males and 12 (39%) were female with ratio 1.6:1 (M: F),  20 (64.5%) were married. , 8 (40%) were endogamous married.  5 (62.5%) were second degree and 3 (37.5%) were third degree.  17 (85%) had children, 2 (10%) of the patient had children with Parkinson’s disease. 22 (71%) had duration more than 12 months, 12 (39%) age more than 40 years.  29 (93.5%) had tremor, 27 (87.1%) had rigidity and 23 (74.2%) had bradykinesia. 14 (45%) had positive family history of Parkinson’s disease. PINK1 gene expression was detected in 28 (90.3%) of the patients. no significant associations were found between PINK1 expression with age, gender, age at onset and family history (P> 0.05). Conclusion: This study concludes that early onset PD was common among male than female. The most affected age group was found to be 41 – 50 years and the mean age of onset 33.4yrs. Also, the patterns of the clinical features were generally similar to literature. PINK1 expression was predominant with no significant associations were found between PINK1 expression with age, gender, age at onset and family history.   Key words: , Early onset,, Parkinson’s disease, Pink1 gene, Sudan.

Manejo y comorbilidades de los trastornos bipolares en la infancia y adolescencia

2020 ◽  
Vol 63 (6) ◽  
pp. 40-50
Author(s):  
Hugo Enrique Hernández-Martínez ◽  
Marta Georgina Ochoa-Madrigal
Keyword(s):  
Bipolar Disorder ◽  
Key Words ◽  
Child Psychiatry ◽  
Affective Disorders ◽  
Age Of Onset ◽  
Bipolar Disorders ◽  
World Population ◽  
Key Words Bipolar Disorder ◽  
The World ◽  
Cardinal Symptoms

The diagnosis and treatment of bipolar disorders (BPD) in children is currently one of the biggest challenges and area of controversy in the field of child psychiatry. Bipolar disorders encompass several affective disorders that involve alterations in the degree of activity, content and form of thinking that are characterized by biphasic episodes of mood. This group of disorders affect approximately 1% of the world population and begin in youth (the average age of onset of ~20 years). However, in some studies a delay of 5 years has been observed since the presentation of symptoms at the beginning of the treatment. Currently, the diagnosis of TBP in children and adolescents should be based on the same set of symptoms applied to adults, as well as the general principles of the treatment. The research carried out around this disorder has resulted in changes in the conceptualization and approach of this pathology, now conceived as a group of disorders that share changes in mood and other cardinal symptoms, of a chronic and progressive nature that impacts in a negative way in those who suffer them. Key words: Bipolar disorder; childhood; mania; hypomania; depression.

Age, Age of Onset and Course of Primary Depressive Illness in the Elderly*

1983 ◽  
Vol 28 (2) ◽  
pp. 102-104 ◽  
Author(s):  
Martin G. Cole
Keyword(s):  
Elderly Patients ◽  
Depressive Episode ◽  
Early Onset ◽  
Age Of Onset ◽  
Late Onset ◽  
The Elderly ◽  
Depressive Illness ◽  
Physical Illness ◽  
Course Of Illness

Thirty-eight elderly patients with primary depressive illness (Feighner criteria) were followed up for 7–31 months. In the absence of persistent organic signs and severe physical illness, age of onset (first depressive episode after 60) but not age was significantly related to course of illness. Compared to early onset depressives, late onset depressives were more likely to remain completely well during the follow-up period and less likely to have frequent or disabling relapses.

scholarly journals Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

2014 ◽  
Vol 44 (16) ◽  
pp. 3455-3467 ◽  
Author(s):  
A. Peters ◽  
L. G. Sylvia ◽  
P. V. da Silva Magalhães ◽  
D. J. Miklowitz ◽  
E. Frank ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Collaborative Care ◽  
Bipolar Depression ◽  
Age At Onset ◽  
Number Needed To Treat ◽  
Systematic Treatment ◽  
Illness Duration ◽  
Bipolar Patients ◽  
Depressive Episodes ◽  
Intensive Psychotherapy

Background.The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy.Method.Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments.Results.Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10–20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes.Conclusions.Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.

Gender and Schizophrenia: Association of Age at Onset with Antecedent, Clinical and Outcome Features

1998 ◽  
Vol 32 (3) ◽  
pp. 415-423 ◽  
Author(s):  
Oye Gureje ◽  
Rotimi W. Bamidele
Keyword(s):  
Functional Outcome ◽  
Early Onset ◽  
Late Onset ◽  
Age At Onset ◽  
Early Age ◽  
Illness Onset ◽  
Gender And Age ◽  
Males And Females ◽  
Clear Method ◽  
Illness Outcome

Objective: There is evidence that gender and age at onset may have a bearing on schizophrenia. The extent to which this differential age at onset influences the clinical features of schizophrenia and its outcome in males and females is not clear. Method: One hundred and twenty outpatients with DSM-III-R schizophrenia were studied to determine the association of antecedent, historical, clinical and 13–year outcome features with age at onset in females (n = 64) and in males (n = 56). Results: Males were significantly younger at illness onset but were not otherwise different from females in antecedent features of illness. For males, age at onset bore little relationship to outcome after 13 years. Females with early onset of illness were more likely to have experienced obstetric complications, to evidence poorer premor-bid functioning, and to have a worse clinical, social and functional outcome than females with late onset. Conclusions: Even though females may have a more benign illness than males, among females, those with early age at onset may be characterised by neurodevel-opmental deviance and worse illness outcome.

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