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16-11-2011 | Mental health | Article

One in ten elderly bipolar disorder patients have mixed symptoms


Free abstract

MedWire News: Around one in 10 elderly patients with bipolar disorder who are in a manic state also show symptoms of moderate or severe depression, study results suggest.

Martha Sajatovic (Case Western Reserve University School of Medicine, Cleveland, Ohio, USA) and team note: "Many individuals with bipolar mania experience admixtures of manic and depressive symptoms. These patients have been reported to have more severe and refractory manic illness, more frequent/intense irritability, agitation, and anxiety and more frequent psychotic features."

However, they add that the association between mixed symptoms and age in bipolar disorder patients is unclear, and "there is remarkably little information available regarding standardized ratings of depressive symptoms in geriatric bipolar mania."

To address these issues, the researchers studied data on 100 elderly patients, aged at least 60 years, with bipolar I disorder who participated in a multicenter treatment study. All of the participants had at least moderate mania symptoms, as indicated by a score of 18 or higher on the Young Mania Rating Scale (YMRS).

The team used both the Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS) to assess depressive symptoms among the patients. The presence of at least moderate bipolar depressive symptoms was defined according to European College of Neuropsychopharmacology (ECNP) Consensus Meeting criteria as a HAM-D of 20 or higher.

The researchers found that 11% of the participants had at least moderate depressive symptoms according to ECNP criteria, with increasing age weakly but significantly associated with lower depression scores.

Patients with at least moderate levels of depression had significantly higher mean scores than other patients for nearly all 17 items on the HAM-D, such as anxiety psychic (3.00 vs 1.16), feelings of guilt (2.27 vs 0.52), somatic symptoms (1.27 vs 0.38), hypochondriasis (1.36 vs 0.45), and agitation (1.09 vs 0.63), with the exception of items relating to appetite and weight loss, work activities, and motor retardation.

Among the group as a whole, total scores on the HAM-D and MADRS were highly correlated, the researchers note in the International Journal of Geriatric Psychiatry.

They also note that total YMRS scores were similar between patients with at least moderate levels of depression and other patients, indicating that manic symptom severity does not appear to be related to depressive symptom severity.

Sajatovic and team conclude: "These preliminary findings suggest that over one in ten bipolar manic elders may have at least moderate concurrent depressive symptoms as measured by ECNP criterion."

They add: "Future studies are needed to further evaluate symptom profiles, clinical correlates, and treatments for bipolar older adults with combined manic and depressive symptoms."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Mark Cowen

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