Depressive features typify bipolar disorder in older patients
medwireNews: Older patients with bipolar disorder are more likely to present with a depressive predominant polarity with melancholic depressive features than their younger counterparts, researchers report.
This implies that “[t]herapy should prioritize the prevention of depressive episodes” in older patients with bipolar disorder, say Eduard Vieta (Hospital Clinic Barcelona, Spain) and colleagues.
They found that 30.9% of 123 patients over 65 years of age had a depressive predominant polarity compared with 22.3% of 470 patients aged 65 years or younger. By contrast, a manic/hypomanic predominant polarity was more common among the younger patients (21.3 vs 10.6%).
The older patients (mean age 77 years) were more likely than the younger patients (mean age 46 years) to have a lifetime history of catatonic (9.1 vs 3.1%) and melancholic (56.3 vs 31.1%) features, whereas atypical depressive symptoms were more common in the younger patients (23.4 vs 12.8%).
As well as these specific differences in predominant polarity and depressive symptoms, the researchers observed several sociodemographic and clinical differences between the older and younger study participants who were all outpatients enrolled in a naturalistic cohort study at the Bipolar Disorders Unit of Hospital Clinic Barcelona.
Older patients were significantly more likely to be married (88.4 vs 53.0%) and professionally unqualified (72.8 vs 44.0%) than younger ones, and were more likely to be diagnosed with bipolar II disorder (41.5 vs 25.5%). Bipolar I disorder was more common in younger patients (70.6 vs 54.5%), as was a family history of affective disorder (64.7 vs 50.9%).
Older patients also had significantly older illness onset than younger patients (40.1 vs 25.2 years) and a significantly later age at first hospitalisation (51.5 vs 29.4 years).
Writing in Acta Psychiatrica Scandinavica, Vieta and co-authors say that the presence of depressive predominant polarity in older patients compared with manic/hypomanic predominant polarity in younger patients is “perhaps the main contribution” of their study.
This is because it provides information about the specific course of the illness and “supports the hypothesis of bipolar disorder in the elderly as a different entity with a specific clinical presentation when compared to younger populations.”
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By Laura Cowen, medwireNews Reporter