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 %83’ünde hipertansiyon, %71’inde diyabet, %23’ünde 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.

Kaynakça

1. Akiskal HS. The bipolar spectrum: research and clinical perspectives. Encephale 1995; 6:3-11.

2. Aziz R, Lorberg B, Tampi RR. Treatments for late-life bipolar disorder. Am J Geriatr Pharmacother 2006; 4:347-364.

3. Shulman KI, Herrmann N. Bipolar disorder in old age. Can Fam Physician 1999; 45:1229-1237.

4. Benazzi F. Classifying mood disorders by age-at-onset instead of polarity. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:86-93.

5. Lopez JD, Arauxo A, Paramo M. Late onset bipolar disorder: following right thalamic injury. Acta Eur Psychiatry 2009; 37: 233-235.

6. Çorapçıoğlu A, Aydemir Ö, Yıldız M ve ark. (1999) DSM- IV Eksen I Bozuklukları (SCID-I) için yapılandırılmış klinik görüşme, klinik versiyon. Ankara, Hekimler Yayın Birliği (Article in Turkish).

7. Özerdem A, Yazıcı O, Oral ET and the Mood Disorders Study Group Psychiatric Association of Turkey. Establishment of a registry program for bipolar illness in Turkey. International Society of Affective Disorders 2nd Biennial Conference-Cancun, Mexico. J Affective Disord 2004; 78 (Suppl.1): 86.

8. Akiskal HS, Akiskal KK. TEMPS: Temperament evaluation of Memphis, Pisa, Paris and San Diego. J Affect Disord 2005; 85:1-2.

9. Vahip S, Kesebir S, Alkan M, Yazici O, Akiskal KK, Akiskal HS. Affective temperaments in clinically-well subjects in Turkey: initial psychometric data on the TEMPS-A. J Affect Disord 2005; 85:113-25.

10. Goodwin FK, Jamison KR. Manic Depressive Illness. New York: Oxford University Press, 1990.

11. Hendrick V, Altshuler LL, Gitlin MJ, Delrahim S, Hammen C. Gender and bipolar illness. J Clin Psychiatry 2000; 61:393-396.

12. Benazzi F. Gender differences in bipolar II and unipolar depressed outpatients: a 557-case study. Ann Clin Psychiatry 1999; 11:55-59.

13. Almeida OP, Fenner S. Bipolar disorder: similarities and differences between patients with illness onset before and after 65 years of age. Int Psychogeriatr 2002; 14:311-322.

14. Robb JC, Young LT, Cooke RG, Joffe RT. Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores. J Affect Disord 1998; 49:189-193.

15. Benazzi F. Early-onset versus late-onset atypical depression: unipolar and bipolar II. J Affect Disord 2000; 61:95-99.

16. Wylie ME, Mulsant BH, Pollock BG, Sweet RA, Zubenko GS, Begley AE, Gregor M, Frank E, Reynolds CF 3rd, Kupfer DJ. Age at onset in geriatric bipolar disorder. Effects on clinical presentation and treatment outcomes in an inpatient sample. Am J Geriatr Psychiatry 1999; 7:77-83.

17. Lieberman DZ, Massey SH, Goodwin FK. The role of gender in single vs married individuals with Bipolar Disorders. Compr Psychiatry 2010, 51: 380-385.

18. Oostervink F, Boomsma MM, Nolen WA; EMBLEM Advisory Board. Bipolar disorder in the elderly; different effects of age and of age of onset. J Affect Disord 2009; 116:176-183.

19. Depp CA, Jeste DV. Bipolar disorder in older adults: a critical review. Bipolar Disord 2004; 6:343-367.

20. Schürhoff F, Bellivier F, Jouvent R, Mouren-Siméoni MC, Bouvard M, Allilaire JF, Leboyer M. Early and late onset bipolar disorders: two different forms of manic-depressive illness? J Affect Disord 2000; 58:215-221.

21. Ortiz A, Bradler K, Slaney C, Garnham J, Ruzickova M, O’Donovan C, Hajek T, Alda M. An admixture analysis of the age at index episodes in bipolar disorder. Psychiatry Res 2011; 188:34-39.

22. Goikolea JM, Colom F, Martínez-Arán A, Sánchez-Moreno J, Giordano A, Bulbena A, Vieta E. Clinical and prognostic implications of seasonal pattern in bipolar disorder: a 10-year follow-up of 302 patients. Psychol Med 2007; 37:1595-1599.

23. Todd RD. Genetics of early onset bipolar affective disorder: are we making progress? Curr Psychiatry Rep 2002; 4:141-145.

24. Ng B, Camacho A, Lara DR, Brunstein MG, Pinto OC, Akiskal HS. A case series on the hypothesized connection between dementia and bipolar spectrum disorders: bipolar type VI? J Affect Disord 2008; 107:307-315.

25. Placidi GF, Signoretta S, Liguori A, Gervasi R, Maremmani I, Akiskal HS. The semi-structured affective temperament interview (TEMPS-I). Reliability and psychometric properties in 1010 14-26-year old students. J Affect Disord 1998; 47:1-10.

26. Cassano GB, Akiskal HS, Musetti L, Perugi G, Soriani A, Mignani V. Psychopathology, temperament, and past course in primary major depressions. 2. Toward a redefinition of bipolarity with a new semistructured interview for depression. Psychopathology 1989; 22:278-288.

27. Hecht H, van Calker D, Spraul G, Bohus M, Wark HJ, Berger M, von Zerssen D. Premorbid personality in patients with uni- and bipolar affective disorders and controls: assessment by the Biographical Personality Interview (BPI). Eur Arch Psychiatry Clin Neurosci 1997; 247:23-30.

28. Kesebir S, Vahip S, Akdeniz F, Yüncü Z. The relationship of affective temperament and clinical features in bipolar disorder. Türk Psikiyatri Derg 2005; 16:164-169.

Kaynak Göster

  • ISSN: 1018-8681
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1984

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