Two years' outcome of acute mania in bipolar disorder: different effects of age and age of onset

Abstract

Older bipolar manic patients did not differ from younger bipolar patients in short-term treatment outcome (remission and recovery), but in the long term, this may be more difficult to maintain. Distinguishing age groups in bipolar study populations may be useful when considering treatment and treatment outcome and warrants further study.

Clinical Characteristics of Patients with Late Life Bipolar Disorder in the Community: Data from the NNDC Registry

“…Furthermore, the older cohort endorsed a lower frequency of depressive symptoms, possibly reflecting the higher use of antidepressant medication, although a prospective clinical trial would be required to conclude cause and effect. This finding is in line with a previous report from Oostervink and colleagues showing that older bipolar patients were more likely to be treated with antidepressants compared to younger patients (37). Studies of antidepressant-induced manic or mixed states have historically not included older bipolar cohorts (19).…”

“…This is consistent with previous findings demonstrating a reduction of lithium use (16, 37) and increase in use of the mood stabilizer, divalproex, in the 1990s despite an absence of data to support the safety and efficacy of divalproex or other mood stabilizers for geriatric mania or maintenance therapy (30). Differences in antidepressant and psychostimulant medication use may be an artifact of missing data from the study sample.…”

“…Polypharmacy of psychotropic medications remains a factor in later life bipolar disorder with both younger (3.1) and older cohorts (3.2) prescribed a similar mean number of psychotropic medications. This finding is similar to the EMBLEM study (37) that also noted combined medication treatment was common in both younger and older patients with bipolar disorder. This underscores the complexity of clinical management of bipolar disorder in both early and later life.…”

“…While there has not been consensus about how to define late-life bipolar disorder most studies have used age cutoffs between 50 and 65 (14, 37). Reports on symptom presentation in older and younger patients with bipolar disorder have produced some conflicting results.…”

Factor analysis of temperament and personality traits in bipolar patients: Correlates with comorbidity and disorder severity

“…An earlier age at onset of BD symptoms is associated with a more severe course of illness (Coryell et al, 2013; Oostervink et al, 2015; Suominen et al, 2007). Similarly, ADHD is highly comorbid with BD (Karaahmet et al, 2013; Perroud et al, 2014), and the presence of ADHD symptoms in childhood is associated with an earlier age of onset of BD (Jerrell et al, 2014; Wozniak et al, 1995) and a poor prognosis (Asherson et al, 2014).…”