Depressive and Anxious Temperaments as Predictors of Late Onset Bipolar Disorder? Preliminary Results of a “Real World” Exploratory Study

Abstract

IntroductionBipolar disorder (BD) onset typically occurs between 15 and 30 years, being diagnosed under the age of 50 in 90% of cases, named “non-late onset BD” (non-LOBD). However, clinical observation of late-onset BD (LOBD) raised some concern regarding a differential psychopathological pattern, outcomes and treatment, including a specific affective temperament vulnerability. Therefore, an exploratory study in the “real world” was carried out by investigating psychopathological and temperamental features of a psychogeriatric cohort of LOBD and non-LOBD subjects.MethodsA total of 180 patients affected with BD-I, BD-II, and Cyclothymic Disorder were screened in a Mood Disorder Outpatient Service, during the timeframe January 2019-August 2021. Out of 78 enrolled outpatients, 66 (33 non-LOBD, 33 LOBD) were recruited, by the retrospective collection of sociodemographic, cognitive, psychopathological and clinical assessment, including the short-version of the Temperament Evaluation of Memphis, Pisa, and San Diego (TEMPS-M).ResultsLOBD is significantly associated with higher rates of BD-II diagnosis (χ2 = 27.692, p < 0.001), depressive episodes (p = 0.025), mixed states (p = 0.009), predominant depressive and anxious affective temperaments (p < 0.001). Non-LOBD is significantly associated with higher endocrinological (χ2 = 6.988, p = 0.008) and metabolic comorbidity (χ2 = 5.987, p = 0.014), a diagnosis of BD-I, manic episodes, and predominant hyperthymic affective temperaments (p = 0.001). GDS (p < 0.001) and MSRS (p = 0.005) scores were significantly higher in LOBD.ConclusionFurther longitudinal studies with larger sample sizes and a control group are needed to determine whether LOBD may represent a distinct psychopathological entity from non-LOBD and evaluate differences (if any) in terms of prognosis and treatment between non-LOBD and LOBD.

Editorial: Late-onset depression and mania: Diagnosis, treatment and life events as risk factors

“…As above mentioned, an important point that still needs to be addressed is whether late-onset depression and mania can be considered as a distinct psychopathological entity from non-late-onset mood disorders. In the current Research Topic, ( 5 ) attempted at disentangling this particular issue, assessing clinical, psychopathological and temperamental features in a sample of Italian individuals aged >50 years old with late-onset bipolar disorders (BD) or non-late-onset BD. The authors found that late onset BD was associated with BD type II diagnosis, depressive episodes, mixed states, and predominant depressive and anxious affective temperaments.…”

“…As above mentioned, an important point that still needs to be addressed is whether late-onset depression and mania can be considered as a distinct psychopathological entity from non-late-onset mood disorders. In the current Research Topic, (5) They used latent profile analysis to determine the optimal cutoff point for the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10), finding a three-profile solution as the best fit. They identified three clinical profiles, including minimal depression, mild depression, and moderate-severe depression.…”