Sermin KESEBİR, Sena ŞAYAKÇI, Özgür SÜNER

Comparison of bipolar patients with and without late onset

Amaç: Bu çalışmanın amacı, geç başlangıçlı iki uçlu bozukluğu olan olguların, geç başlangıçlı olmayan olgulardan farklılaşıp farklılaşmadığının incelenmesidir. Yöntem: Bu çalışmada, DSM-IV ölçütlerine göre iki uçlu bozukluk tanılı ve polikliniğimizde izlenmekte olan 144 olgu değerlendirilmiştir. İki uçlu bozuklukta geç başlangıç sınırı olarak 40 yaş seçilmiştir. Geriye dönük olarak geç başlangıçlı olduğu saptanan 17 olgu, geç başlangıçlı olmayan 127 olgu ile karşılaştırılmıştır. Bulgular: Geç başlangıçlı olgularda psikotik bulgulu dönem, karma dönem, hızlı döngülülük, mevsimsellik ve antidepresan ile kayma daha sık, hipertimik mizaç puanları daha yüksek bulundu. Bedensel hastalık eştanısı geç başlangıçlı olgular arasında daha sıktı. Olguların %83ünde hipertansiyon, %71inde diyabet, %23ünde ise serebrovasküler hastalık eştanısı belirlendi. Ailede bedensel hastalık öyküsü de geç başlangıçlı olgularda daha sıktı. Sonuç: İki uçlu bozuklukta başlangıç yaşı, farklı alttipleri belirlemede, hastalığın farklı klinik gidişlerini ve eştanıları öngörmede önemli bir belirleyici olarak değerlendirilmektedir. Özellikle, geç başlangıçlı olgularda daha sık bulunduğu saptanan vasküler patolojiler, bu olgularda dikkatle incelenmeli, ayrıntılı bir genel tıbbi durum değerlendirmesinin gerekliliği göz ardı edilmemelidir.

Geç başlangıçlı olan ve olmayan iki uçlu bozukluk hastalarının karşılaştırılması

Comparison of bipolar patients with and without late onset Objective: The aim of this study was to find out if late onset bipolar patients were different from bipolar patients without late onset disorder. Methods: In this study, we evaluated 144 bipolar cases which met DSM IV diagnosis criteria. Our cut-off for late onset bipolar disorder was 40 years of age. Seventeen cases who were retrospectively determined as having late onset disease were compared with 127 non late onset cases. Results: Psychotic and mixed episodes, rapid cycling, seasonality and switch with antidepressants were more frequent and hyperthymic temperament scores were higher in patients with late onset disease. Comorbid diseases were more frequent in the late onset patient group: 83% had hypertension, 71% had diabetes mellitus and 23% had cerebrovascular disease. Family history for medical illness was more frequent among late onset patients also. Conclusions: In bipolar disorder, age of onset is accepted as an important marker in determining different subtypes and in predicting different clinical courses and comorbidity. Vascular pathologies which were determined more frequently, especially in late onset cases must be evaluated carefully and the necessity for a general medical examination must not be ignored.

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