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Dols A, Sekhon H, Rej S, Klaus F, Bodenstein K, Sajatovic M. Bipolar Disorder Among Older Adults: Newer Evidence to Guide Clinical Practice. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:370-379. [PMID: 38695001 PMCID: PMC11058954 DOI: 10.1176/appi.focus.20230010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The term older-age bipolar disorder (OABD) refers to patients with bipolar disorder who are ages 50 and older. Research findings suggest important differences, including the attenuation of manic symptoms with age and the occurrence of multiple somatic comorbid conditions. Although the pharmacological treatment of OABD is fairly similar, adverse effects, somatic comorbidity, and drug-drug interactions are more common. Lithium is effective in treating OABD and may have the potential to be neuroprotective. Anticonvulsants and second-generation antipsychotics have a growing evidence supporting their use in treating OABD. Behavioral intervention can be a helpful adjunct to pharmacological treatment. Clinicians and health care systems need to be prepared to provide care and services to individuals with bipolar disorder throughout the life span. Although older adults have typically been excluded from bipolar disorder RCTs, emerging efforts organized by global advocates and harnessing teams of clinicians and scientists have the potential to advance care.
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Affiliation(s)
- Annemiek Dols
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Harmehr Sekhon
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Soham Rej
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Federica Klaus
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Katie Bodenstein
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Martha Sajatovic
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
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Warner A, Holland C, Lobban F, Tyler E, Harvey D, Newens C, Palmier-Claus J. Physical health comorbidities in older adults with bipolar disorder: A systematic review. J Affect Disord 2023; 326:232-242. [PMID: 36709829 DOI: 10.1016/j.jad.2023.01.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To ascertain the prevalence and predictors of physical health comorbidities in older adults with bipolar disorder. METHODS The authors conducted a systematic review and narrative synthesis of peer-reviewed journal articles reporting on physical health comorbidities in older adults (aged ≥50) with a diagnosis of bipolar disorder. The Mixed Methods Appraisal Tool (MMAT) assessed study quality. RESULTS 23 papers reporting on 19 studies met the inclusion criteria. The literature on diabetes, obesity and renal disease was inconclusive. There was some tentative evidence to higher rates of cardiovascular disease and some forms of cancer in older adults with bipolar disorder in comparison to the general population, but this requires further investigation. We identified no studies looking at oral health. LIMITATIONS The quality ratings of the identified research were generally low. Very few studies included a comparison sample from the general population or controlled for key covariates in their analysis. CONCLUSION Existing literature provides tentative evidence that some physical health comorbidities are elevated in older adults with bipolar disorder. Clinicians should consider interventions that improve the physical health of this group, alongside the chronic mental health difficulties they experience.
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Affiliation(s)
- Aaron Warner
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster, UK; Centre for Ageing Research, Division of Health Research, Lancaster, UK.
| | - Carol Holland
- Centre for Ageing Research, Division of Health Research, Lancaster, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster, UK; Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Elizabeth Tyler
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Daisy Harvey
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster, UK
| | - Connie Newens
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Jasper Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster, UK; Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
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Elefante C, Brancati GE, Torrigiani S, Amadori S, Ricciardulli S, Pistolesi G, Lattanzi L, Perugi G. Bipolar Disorder and Manic-Like Symptoms in Alzheimer's, Vascular and Frontotemporal Dementia: A Systematic Review. Curr Neuropharmacol 2023; 21:2516-2542. [PMID: 35794767 PMCID: PMC10616925 DOI: 10.2174/1570159x20666220706110157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND An increased risk of manic episodes has been reported in patients with neurodegenerative disorders, but the clinical features of bipolar disorder (BD) in different subtypes of dementia have not been thoroughly investigated. OBJECTIVES The main aim of this study is to systematically review clinical and therapeutic evidence about manic syndromes in patients with Alzheimer's disease (AD), vascular dementia (VaD), and frontotemporal dementia (FTD). Since manic-mixed episodes have been associated to negative outcomes in patients with dementia and often require medical intervention, we also critically summarized selected studies with relevance for the treatment of mania in patients with cognitive decline. METHODS A systematic review of the literature was conducted according to PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched up to February 2022. Sixty-one articles on patients with AD, VaD, or FTD and BD or (hypo) mania have been included. RESULTS Manic symptoms seem to be associated to disease progression in AD, have a greatly variable temporal relationship with cognitive decline in VaD, and frequently coincide with or precede cognitive impairment in FTD. Overall, mood stabilizers, and electroconvulsive therapy may be the most effective treatments, while the benefits of short-term treatment with antipsychotic agents must be balanced with the associated risks. Importantly, low-dose lithium salts may exert neuroprotective activity in patients with AD. CONCLUSION Prevalence, course, and characteristics of manic syndromes in patients with dementia may be differentially affected by the nature of the underlying neurodegenerative conditions.
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Affiliation(s)
- Camilla Elefante
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Giulio Emilio Brancati
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Samuele Torrigiani
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Salvatore Amadori
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Sara Ricciardulli
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Gabriele Pistolesi
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
| | - Lorenzo Lattanzi
- Psychiatry Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
- G. De Lisio Institute of Behavioral Sciences, Pisa, Italy
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Batinic B, Ristic I, Zugic M, Baldwin DS. Treatment of Symptom Clusters in Schizophrenia, Bipolar Disorder and Major Depressive Disorder With the Dopamine D3/D2 Preferring Partial Agonist Cariprazine. Front Psychiatry 2021; 12:784370. [PMID: 34887792 PMCID: PMC8649660 DOI: 10.3389/fpsyt.2021.784370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/02/2021] [Indexed: 01/07/2023] Open
Abstract
Cariprazine is currently approved for the treatment of patients with schizophrenia (USA and EU), and for manic, depressive, and episodes with mixed features in bipolar I disorder (USA): several randomized controlled studies have also explored its efficacy in patients with major depressive disorder. This review summarizes its current therapeutic uses and potential advantages for treating the main symptoms of schizophrenia, bipolar I and major depressive disorder, considering its pharmacodynamic properties, efficacy, and tolerability. Its predominantly D3 receptor preferring affinity, with functional selectivity according to the prevailing neuronal environment, contributes to its efficacy across a wide array of psychopathological symptoms (including reality distortion, disorganized thought, negative symptoms, mood disturbance, anhedonia, and cognitive impairment), and to a favorable side effect profile. Cariprazine may be a "drug of choice" in patients with predominant negative and cognitive symptoms of schizophrenia, as well as those with metabolic syndrome. Further investigation of its relative efficacy when compared to aripiprazole or other active comparators is warranted. Its effectiveness in the treatment of bipolar mania, bipolar I depression and bipolar I episodes with mixed features, with minimal accompanying metabolic changes is well-established. The longer half-life and delayed time to relapse in patients diagnosed with schizophrenia when compared to other second-generation antipsychotics represent other advantages, given the high rates of non-adherence and frequent relapses seen in clinical practice. Its efficacy in overlapping symptom domains in other major psychiatric disorders appears promising.
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Affiliation(s)
- Borjanka Batinic
- Clinic of Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
- Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Ivan Ristic
- Department of Epidemiology, Medical School, University of Belgrade, Belgrade, Serbia
- Department of Psychiatry, Institute of Mental Health, Belgrade, Serbia
| | - Milica Zugic
- Department of Psychiatry, Institute of Mental Health, Belgrade, Serbia
| | - David S. Baldwin
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Ljubic N, Ueberberg B, Grunze H, Assion HJ. Treatment of bipolar disorders in older adults: a review. Ann Gen Psychiatry 2021; 20:45. [PMID: 34548077 PMCID: PMC8456640 DOI: 10.1186/s12991-021-00367-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/04/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Old age bipolar disorder has been an orphan of psychiatric research for a long time despite the fact that bipolar disorder (BD)-I and II together may affect 0.5-1.0% of the elderly. It is also unclear whether aetiology, course of illness and treatment should differ in patients with a first manifestation in older age and patients suffering from a recurrence of a BD known for decades. This narrative review will summarize the current state of knowledge about the epidemiology, clinical features, and treatment of BD in the elderly. METHODS We conducted a Medline literature search from 1970 to 2021 using MeSH terms "Bipolar Disorder" × "Aged" or "Geriatric" or "Elderly". Search results were complemented by additional literature retrieved from examining cross references and by hand search in text books. Varying cut-off ages have been applied to differentiate old age from adult age BD. Within old age BD, there is a reasonable agreement of distinct entities, early and late-onset BD. They differ to some extent in clinical symptoms, course of illness, and some co-morbidities. Point prevalence of BD in older adults appears slightly lower than in working-age adults, with polarity of episodes shifting towards depression. Psychopharmacological treatment needs to take into account the special aspects of somatic gerontology and the age-related change of pharmacokinetic and pharmacodynamic characteristics. The evidence for commonly used treatments such as lithium, mood-stabilizing antiepileptics, antipsychotics, and antidepressants remains sparse. Preliminary results support a role of ECT as well as psychotherapy and psychosocial interventions in old age BD. CONCLUSIONS There is an obvious need of further research for all treatment modalities of BD in old age. The focus should be pharmacological and psychosocial approaches, as well as their combination, and the role of physical treatment modalities such as ECT.
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Affiliation(s)
- Nemanja Ljubic
- Bereich Forschung & Wissenschaft, LWL-Klinik, Marsbruchstr. 179, 44287, Dortmund, Germany
| | - Bianca Ueberberg
- Bereich Forschung & Wissenschaft, LWL-Klinik, Marsbruchstr. 179, 44287, Dortmund, Germany
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, Ringstraße. 1, 74523, Schwäbisch Hall, Germany.
- Paracelsus Medical University, Ernst-Nathan Straße 1, 90419, Nuremberg, Germany.
| | - Hans-Jörg Assion
- Bereich Forschung & Wissenschaft, LWL-Klinik, Marsbruchstr. 179, 44287, Dortmund, Germany
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Tyler E, Lobban F, Long R, Jones SH. Developing a recovery-focused therapy for older people with bipolar disorder: a qualitative focus group study. BMJ Open 2021; 11:e049829. [PMID: 34348954 PMCID: PMC8340279 DOI: 10.1136/bmjopen-2021-049829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES As awareness of bipolar disorder (BD) increases and the world experiences a rapid ageing of the population, the number of people living with BD in later life is expected to rise substantially. There is no current evidence base for the effectiveness of psychological interventions for older adults with BD. This focus group study explored a number of topics to inform the development and delivery of a recovery-focused therapy (RfT) for older adults with BD. DESIGN A qualitative focus group study. SETTING Three focus groups were conducted at a university in the North West of England. PARTICIPANTS Eight people took part in the focus groups; six older adults with BD, one carer and one friend. RESULTS Participant's responses clustered into six themes: (1) health-related and age-related changes in later life, (2) the experience of BD in later life, (3) managing and coping with BD in later life, (4) recovery in later life, (5) seeking helping in the future and (6) adapting RfT for older people. CONCLUSIONS Participants reported a range of health-related and age-related changes and strategies to manage their BD. Participants held mixed views about using the term 'recovery' in later life. Participants were in agreement that certain adaptations were needed for delivering RfT for older adults, based on their experience of living with BD in later life. The data collected as part of the focus groups have led to a number of recommendations for delivering RfT for older adults with BD in a randomised controlled trial (Clinical Trial Registration: ISRCTN13875321).
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Affiliation(s)
- Elizabeth Tyler
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Fiona Lobban
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Rita Long
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Steven H Jones
- Division of Health Research, Lancaster University, Lancaster, UK
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Arnold I, Dehning J, Grunze A, Hausmann A. Old Age Bipolar Disorder-Epidemiology, Aetiology and Treatment. ACTA ACUST UNITED AC 2021; 57:medicina57060587. [PMID: 34201098 PMCID: PMC8226928 DOI: 10.3390/medicina57060587] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 01/10/2023]
Abstract
Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called “late onset” patients (LOBD), and the elder patients with a long-standing clinical history, the so called “early onset” patients (EOBD). The aim of the present literature review is to provide more information on specific issues concerning OABD, such as epidemiology, aetiology and treatments outcomes. We conducted a Medline literature search from 1970–2021 using the MeSH terms “bipolar disorder” and “aged” or “geriatric” or “elderly”. The additional literature was retrieved by examining cross references and by a hand search in textbooks. With sparse data on the treatment of OABD, current guidelines concluded that first-line treatment of OABD should be similar to that for working-age bipolar disorder, with specific attention to side effects, somatic comorbidities and specific risks of OABD. With constant monitoring and awareness of the possible toxic drug interactions, lithium is a safe drug for OABD patients, both in mania and maintenance. Lamotrigine and lurasidone could be considered in bipolar depression. Mood stabilizers, rather than second generation antipsychotics, are the treatment of choice for maintenance. If medication fails, electroconvulsive therapy is recommended for mania, mixed states and depression, and can also be offered for continuation and maintenance treatment. Preliminary results also support a role of psychotherapy and psychosocial interventions in old age BD. The recommended treatments for OABD include lithium and antiepileptics such as valproic acid and lamotrigine, and lurasidone for bipolar depression, although the evidence is still weak. Combined psychosocial and pharmacological treatments also appear to be a treatment of choice for OABD. More research is needed on the optimal pharmacological and psychosocial approaches to OABD, as well as their combination and ranking in an evidence-based therapy algorithm.
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Affiliation(s)
- Ivan Arnold
- Helios Klinik Berlin-Buch, 13125 Berlin, Germany;
| | - Julia Dehning
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, 6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-504-83802
| | - Anna Grunze
- Psychiatrisches Zentrum Nordbaden, 69168 Wiesloch, Germany;
| | - Armand Hausmann
- Private Practice, Wilhelm-Greil-Straße 5, 6020 Innsbruck, Austria;
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Tampi RR, Joshi P, Bhattacharya G, Gupta S. Evaluation and treatment of older-age bipolar disorder: a narrative review. Drugs Context 2021; 10:dic-2021-1-8. [PMID: 34113387 PMCID: PMC8166731 DOI: 10.7573/dic.2021-1-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This narrative review aims to synthesize information from the literature regarding older-age bipolar disorder (OABD) in order to provide up-to-date information on this important illness. Methods We searched Ovid (Medline, Embase and PsychInfo) on October 1, 2020, using the keywords “bipolar disorder”, “older adults” and “elderly” to identify relevant articles on OABD. Additionally, the bibliography of identified articles was reviewed for pertinent studies. Discussions OABD is a term that is used to describe bipolar disorder (BD) occurring amongst individuals ≥50 years of age. Evidence indicates that OABD accounts for a quarter of all cases of BD. When compared to individuals with early-onset BD, individuals with OABD have a greater association with cerebrovascular disease and other neurological disorders, less family history of mood disorders, and utilize almost four times the total amount of mental health services. In addition, they are four times more likely to have psychiatric hospitalizations when compared to age-matched controls. Despite a dearth of controlled studies on the use of pharmacotherapy amongst individuals with OABD, available evidence from mixed-age studies indicates the efficacy of commonly used medications in individuals with early-onset BD. Additionally, psychosocial treatments have been found to be effective as adjunctive management strategies amongst individuals with OABD. Furthermore, electroconvulsive therapy may be effective in the treatment of refractory cases of OABD. Conclusions There is a great need for an improved understanding of the phenomenology and neurobiology of OABD. Additionally, research into effective treatments for this serious psychiatric disorder will mitigate the suffering of individuals with OABD.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Pallavi Joshi
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Gargi Bhattacharya
- Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
| | - Sheila Gupta
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, Buffalo NY, USA
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Jones M, Corcoran A, Jorge RE. The psychopharmacology of brain vascular disease/poststroke depression. PSYCHOPHARMACOLOGY OF NEUROLOGIC DISEASE 2019; 165:229-241. [DOI: 10.1016/b978-0-444-64012-3.00013-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Bauer IE, Diniz BS, Meyer TD, Teixeira AL, Sanches M, Spiker D, Zunta-Soares G, Soares JC. Increased reward-oriented impulsivity in older bipolar patients: A preliminary study. J Affect Disord 2018; 225:585-592. [PMID: 28886499 PMCID: PMC5626658 DOI: 10.1016/j.jad.2017.08.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/02/2017] [Accepted: 08/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Impulsivity is a well-established trait of bipolar disorder (BD) that persists across mood phases. It is, however, still unknown whether, in BD, impulsivity remains stable or varies in intensity over the lifespan. This cross-sectional study compared impulsive behavior in older euthymic BD patients and healthy individuals using a range of self-rating and behavioral measures of impulsivity. METHODS 28 BD patients (56.07 ± 4.08 years, 16 women) and 15 healthy controls (HC; 55.1 ± 3.95 years, 6 women) were administered the Barratt Impulsivity Scale (BIS) and selected tasks of the Cambridge Neuropsychological Test Automated Batter (CANTAB) reflecting impulsivity. Multivariate analysis of variance controlled for age compared impulsivity measures across BD and HC. RESULTS BD patients displayed poor decision making, risk taking, and increased delay aversion. Other measures of impulsivity such as response inhibition, sustained cognitive control, and BIS scores were, overall, comparable between BD and HC. CONCLUSIONS These preliminary findings suggest that, in BD, aspects of impulsivity related to reward-based decision making persist into late adulthood. Large scale, longitudinal studies are needed to evaluate the relationship of age to impulsivity over time, and explore the link between impulsivity and illness progression in elderly individuals with BD.
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Affiliation(s)
- Isabelle E. Bauer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Breno Satler Diniz
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Thomas D. Meyer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Antonio Lucio Teixeira
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Marsal Sanches
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States,Archway Mental Health Services, 58502 Bismarck, ND, United States
| | - Danielle Spiker
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Giovana Zunta-Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Jair C. Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
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Bocchetta A, Cabras F, Pinna M, Poddighe A, Sardu C, Ardau R, Chillotti C, Del Zompo M. An observational study of 110 elderly lithium-treated patients followed up for 6 years with particular reference to renal function. Int J Bipolar Disord 2017; 5:19. [PMID: 28393327 PMCID: PMC5457744 DOI: 10.1186/s40345-017-0089-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent observational studies have focused on lithium treatment in the elderly, with particular reference to safety in terms of thyroid and renal functions. The purpose of this study was to compare the clinical characteristics of patients starting lithium treatment before (N = 79) or after (N = 31) the age of 65 years. Patients were followed up for 6 years with focus on renal function and prescription of levothyroxine and methimazole. RESULTS At baseline, median lithium serum concentration was 0.55 mmol/l. The estimated glomerular filtration rate was lower than 60 ml/min/1.73 m2 in 43 (39%) patients. In a multiple regression analysis controlling for age and gender, we found a significant effect of duration of lithium treatment on estimated glomerular filtration rate (-0.85 ml/min/1.73 m2 per year of prior exposure). The annual decline during follow-up was 2.3 ml/min/1.73 m2. Two patients were prescribed levothyroxine, and two were prescribed methimazole for the first time during follow-up. CONCLUSIONS Median lithium serum concentration in this cohort of elderly patients with mainly bipolar disorders was lower than the therapeutic range indicated for younger adults. The decline in glomerular filtration rate may be accelerated by long-term lithium use. Thyroid and renal functions continue to require close monitoring throughout the course of lithium treatment. Trial registration NP/2013/3836. Registered 24 June 2013.
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Affiliation(s)
- Alberto Bocchetta
- Unit of Clinical Pharmacology, Azienda Ospedaliero-Universitaria di Cagliari, "San Giovanni di Dio" Hospital, Via Ospedale 54, 09124, Cagliari, Italy.,Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Francesca Cabras
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Martina Pinna
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Claudia Sardu
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Raffaella Ardau
- Unit of Clinical Pharmacology, Azienda Ospedaliero-Universitaria di Cagliari, "San Giovanni di Dio" Hospital, Via Ospedale 54, 09124, Cagliari, Italy
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, Azienda Ospedaliero-Universitaria di Cagliari, "San Giovanni di Dio" Hospital, Via Ospedale 54, 09124, Cagliari, Italy
| | - Maria Del Zompo
- Unit of Clinical Pharmacology, Azienda Ospedaliero-Universitaria di Cagliari, "San Giovanni di Dio" Hospital, Via Ospedale 54, 09124, Cagliari, Italy. .,Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy.
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De Fazio P, Gaetano R, Caroleo M, Pavia M, De Sarro G, Fagiolini A, Segura-Garcia C. Lithium in late-life mania: a systematic review. Neuropsychiatr Dis Treat 2017; 13:755-766. [PMID: 28331326 PMCID: PMC5352229 DOI: 10.2147/ndt.s126708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The prevalence of mania among >65-year-olds ranges from 0.1% to 0.4% and its treatment is a particular challenge for clinicians. Although lithium is the treatment of choice for bipolar disorder (BD), its use in elderly population was recently questioned. This study provides a comprehensive review of literature on the efficacy and tolerability of lithium as a pharmacologic treatment for mania in elderly BD patients. We conducted a systematic review, based on PRISMA guidelines, of articles published between 1970 and August 2016 and indexed in the following databases: EMBASE, MEDLINE, Cochrane Library Databases and PsycINFO. The key words "age", "late-life", "geriatric", "elderly", and "older" were combined with words indicating pharmacologic treatments, such as lithium and other mood stabilizers and with the diagnostic terms "bipolar disorder" and "mania". Fifteen out of 196 retrieved studies met our inclusion criteria. Seven studies evaluated both the efficacy and tolerability of lithium treatment in elderly BD patients; a further three evaluated only the efficacy and five assessed tolerability. Only limited data on the treatment of elderly BD patients are available, but evidence suggests that lithium is effective and tolerated in this subgroup of patients and thus should remain a first-line drug. It seems to be more effective at lower doses and close monitoring of plasma concentrations is necessary.
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Affiliation(s)
- Pasquale De Fazio
- Department of Health Sciences, Psychiatric Unit, University Magna Græcia of Catanzaro
| | - Raffaele Gaetano
- Department of Health Sciences, Psychiatric Unit, University Magna Græcia of Catanzaro
| | - Mariarita Caroleo
- Department of Health Sciences, Psychiatric Unit, University Magna Græcia of Catanzaro
| | - Maria Pavia
- Department of Health Science, University Magna Græcia
| | - Giovanbattista De Sarro
- Department of Health Sciences, Institute of Pharmacology, University Magna Græcia, Catanzaro
| | - Andrea Fagiolini
- Department of Molecular Medicine, Division of Psychiatry, University of Siena, Siena, Italy
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13
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Safari R, Salimi R, Tunca Z, Ozerdem A, Ceylan D, Sakizli M. Mutation/SNP analysis in EF-hand calcium binding domain of mitochondrial Ca2+ uptake 1 gene in bipolar disorder patients. J Integr Neurosci 2016; 15:163-73. [DOI: 10.1142/s0219635216500096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kleimann A, Schrader V, Stübner S, Greil W, Kahl KG, Bleich S, Grohmann R, Frieling H, Toto S. Psychopharmacological treatment of 1650 in-patients with acute mania-data from the AMSP study. J Affect Disord 2016; 191:164-71. [PMID: 26655125 DOI: 10.1016/j.jad.2015.11.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Several studies have analyzed prescription patterns for bipolar disorder, but few have for acute mania. Treatment strategies in this complex domain change over time and do not always follow evidence-based guidelines. METHODS Prescription data of in-patients suffering from acute mania in the time period from 2005 to 2012 were obtained from the database of the Drug Safety Program in Psychiatry (Institut für Arzneimittelsicherheit in der Psychiatrie; AMSP). Data were collected on two index dates per year. Changes over time were analyzed comparing the time periods 2005/06 and 2011/12. RESULTS Among 1650 patients (mean ±SD; age: 48.9±14.91 years; 53.1% females) 54.1% received anticonvulsants, 74.5% second-generation antipsychotics (SGAs), 17.8% first-generation antipsychotics (FGAs), 29.1% lithium, 44.1% benzodiazepines and 14.5% antidepressants. Prescription of SGAs increased from 70% to 79% (p=0.005), while prescription of FGAs and anticonvulsants decreased from 19% to 13% (p<0.05) and 59% to 46% (p<0.001), respectively. Only 30% of patients received monotherapy with one mood stabilizer. We observed an impact of gender, age and psychotic symptoms on treatment strategy. 36.8% of the women≤40 years received valproate. LIMITATIONS Follow-up data are missing and no differentiation between acute and maintenance treatments could be made due to the cross-sectional design. Additionally, our findings do not necessarily translate to outpatients or to other countries. CONCLUSIONS Combination therapies represent standard clinical practice. Though many results reflect clinical necessity, the high number of antidepressant prescriptions or valproate use in women of child-bearing age should be judged critically. Further prospective studies should focus on real-world prescription practice in acute mania to evaluate efficacy and safety of common practice. This paper is dedicated to Prof. Dr. Hanns Hippius on the occasion of his 90th birthday.
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Affiliation(s)
- Alexandra Kleimann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
| | - Viktoria Schrader
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Waldemar Greil
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany; Psychiatric Hospital Kilchberg, Kilchberg-Zurich, Switzerland
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry, Ludwig Maximilian University, Munich, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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15
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Ivanets NN, Kinkulkina MA, Avdeeva TI, Tikhonova YG, Luk’ianova AV. An increase in the efficacy of psychopharmacotherapy of late-onset depressions: combination and substitution of antidepressants. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:43-51. [DOI: 10.17116/jnevro20161165143-51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Berlin RK, Butler PM, Perloff MD. Gabapentin Therapy in Psychiatric Disorders: A Systematic Review. Prim Care Companion CNS Disord 2015; 17:15r01821. [PMID: 26835178 DOI: 10.4088/pcc.15r01821] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/12/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Gabapentin is commonly used off-label in the treatment of psychiatric disorders with success, failure, and controversy. A systematic review of the literature was performed to elucidate the evidence for clinical benefit of gabapentin in psychiatric disorders. DATA SOURCES Bibliographic reference searches for gabapentin use in psychiatric disorders were performed in PubMed and Ovid MEDLINE search engines with no language restrictions from January 1, 1983, to October 1, 2014, excluding nonhuman studies. For psychiatric references, the keywords bipolar, depression, anxiety, mood, posttraumatic stress disorder (posttraumatic stress disorder and PTSD), obsessive-compulsive disorder (obsessive-compulsive disorder and OCD), alcohol (abuse, dependence, withdraw), drug (abuse, dependence, withdraw), opioid (abuse, dependence, withdraw), cocaine (abuse, dependence, withdraw), and amphetamine (abuse, dependence, withdraw) were crossed with gabapentin OR neurontin. STUDY SELECTION AND DATA EXTRACTION The resulting 988 abstracts were read by 2 reviewers; references were excluded if gabapentin was not a study compound or psychiatric symptoms were not studied. The resulting references were subsequently read, reviewed, and analyzed; 219 pertinent to gabapentin use in psychiatric disorders were retained. Only 34 clinical trials investigating psychiatric disorders contained quality of evidence level II-2 or higher. RESULTS Gabapentin may have benefit for some anxiety disorders, although there are no studies for generalized anxiety disorder. Gabapentin has less likely benefit adjunctively for bipolar disorder. Gabapentin has clearer efficacy for alcohol craving and withdrawal symptoms and may have a role in adjunctive treatment of opioid dependence. There is no clear evidence for gabapentin therapy in depression, PTSD prevention, OCD, or other types of substance abuse. Limitations of available data include variation in dosing between studies, gabapentin as monotherapy or adjunctive treatment, and differing primary outcomes between trials. CONCLUSIONS Further research is required to better clarify the benefit of gabapentin in psychiatric disorders.
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Affiliation(s)
- Rachel K Berlin
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Paul M Butler
- Department of Neurology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Michael D Perloff
- Department of Neurology, Boston University School of Medicine, Boston University Medical Center, Boston, Massachusetts
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17
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Abstract
OBJECTIVE This article presents the case of an elderly woman experiencing a depressive phase of Bipolar Affective Disorder 1 (BPAD1), who required electroconvulsive therapy (ECT), prior to which her lithium was ceased, and who developed ultra-ultra-rapid cycling (UURC) and ultra-rapid cycling (URC). This resolved with the recommencement of lithium and continuation of ECT. METHOD Case report and review of the relevant literature. RESULTS The patient's mood stabilized with recommencement of lithium and continuation of ECT. CONCLUSIONS Ceasing lithium prior to ECT may carry a risk of URC or UURC in BPAD1.
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Affiliation(s)
| | - David Burke
- Director, Psychogeriatric Service, St Vincent's Hospital, Sydney, NSW, and; Associate Professor, University of Notre Dame, Sydney, NSW, Australia
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18
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Riepe MW, Walther B, Vonend C, Beer AJ. Drug-induced cerebral glucose metabolism resembling Alzheimer's Disease: a case study. BMC Psychiatry 2015; 15:157. [PMID: 26163145 PMCID: PMC4498558 DOI: 10.1186/s12888-015-0531-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 06/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With aging of society the absolute number and the proportion of patients with cognitive deficits increase. Multiple disorders and diseases can foster cognitive impairment, e.g., Alzheimer's disease (AD), depressive disorder, or polypharmacy. CASE PRESENTATION A 74 year old man presented to the Old Age Psychiatry Service with cognitive deficits while being treated for recurrent depressive episodes and essential tremor with Venlafaxine, Lithium, and Primidone. Neuropsychological testing revealed a medio-temporal pattern of deficits with pronounced impairment of episodic memory, particularly delayed recall. Likewise, cognitive flexibility, semantic fluency, and attention were impaired. Positron emission tomography (PET) with fluorodeoxyglucose was performed and revealed a pattern of glucose utilization deficit resembling AD. On cessation of treatment with Lithium and Primidone, cognitive performance improved, particularly episodic memory performance and cognitive flexibility. Likewise, glucose metabolism normalized. Despite normalization of both, clinical symptoms and glucose utilization, the patient remained worried about possible underlying Alzheimer's disease pathology. To rule this out, an amyloid-PET was performed. No cortical amyloid was observed. CONCLUSION Pharmacological treatment of older subjects may mimic glucose metabolism and clinical symptoms of Alzheimer's disease. In the present case both, imaging and clinical findings, reversed to normal on change of treatment. Amyloid PET is a helpful tool to additionally rule out underlying Alzheimer's disease in situations of clinical doubt even if clinical or other imaging findings are suggestive of Alzheimer's disease.
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Affiliation(s)
- Matthias W. Riepe
- Division of Mental Health & Old Age Psychiatry, Psychiatry II, University of Ulm, Ludwig-Heilmeyer-Strasse 2, D-89312 Günzburg, Germany
| | - Britta Walther
- Division of Mental Health & Old Age Psychiatry, Psychiatry II, University of Ulm, Ludwig-Heilmeyer-Strasse 2, D-89312, Günzburg, Germany.
| | - Catharina Vonend
- Department of Nuclear Medicine, Ulm University, Albert-Einstein Allee 23, D-89081, Ulm, Germany.
| | - Ambros J. Beer
- Division of Mental Health & Old Age Psychiatry, Psychiatry II, University of Ulm, Ludwig-Heilmeyer-Strasse 2, D-89312 Günzburg, Germany
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Sajatovic M, Dines P, Fuentes-Casiano E, Athey M, Cassidy KA, Sams J, Clegg K, Locala J, Stagno S, Tatsuoka C. Asenapine in the treatment of older adults with bipolar disorder. Int J Geriatr Psychiatry 2015; 30:710-9. [PMID: 25335125 PMCID: PMC4830381 DOI: 10.1002/gps.4213] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/19/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE In spite of growing numbers of older people, there are few treatment studies on late-life bipolar disorder (BD). This was a 12-week prospective, open-label trial to assess efficacy and tolerability of adjunct asenapine in non-demented older adults (≥ 60 years) with sub-optimal previous response to BD treatments. METHODS Asenapine was initiated at 5 mg/day and titrated as tolerated. Effects on global psychopathology were measured with Clinical Global Impression, bipolar version (CGI-BP), and the Brief Psychiatric Rating Scale (BPRS). Mood polarity severity was measured with the Hamilton Depression Rating Scale, Montgomery Asberg Depression Rating Scale, and Young Mania Rating Scale. Other outcomes included the World Health Organization Disability Assessment Schedule II. RESULTS Fifteen individuals were enrolled (mean age 68.6, SD 6.12; 53% female; 73% Caucasian, 13% African American, and 7% Asian). There were 4/15 (27%) individuals who prematurely terminated the study, whereas 11/15 (73%) completed the study. There were significant improvements from baseline on the BPRS (p < 0.05), on CGI-BP overall (p < 0.01), and on CGI-BP mania (p < 0.05) and depression (p < 0.01) subscales. The mean dose of asenapine was 11.2 (SD 6.2) mg/day. The most common reported side effects were gastrointestinal discomfort (n = 5, 33%), restlessness (n = 2, 13%), tremors (n = 2, 13%), cognitive difficulties (n = 2, 13%), and sluggishness (n = 2, 13%). CONCLUSIONS Older people with BD had global improvements on asenapine. Most reported adverse effects were mild and transient, but adverse effects prompted drug discontinuation in just over one quarter of patients. Although risks versus benefits in older people must always be carefully considered, asenapine may be a treatment consideration for some non-demented geriatric BD patients.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Philipp Dines
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Edna Fuentes-Casiano
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Melanie Athey
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Kristin A. Cassidy
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Johnny Sams
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Kathleen Clegg
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Joseph Locala
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Susan Stagno
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Safari R, Tunca Z, Ozerdem A, Ceylan D, Yazicioglu CE, Sakizli M. New alterations at potentially regulated regions of the Glial Derived Neurotrophic Factor gene in bipolar disorder. J Affect Disord 2015; 167:244-50. [PMID: 24997227 DOI: 10.1016/j.jad.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/02/2014] [Accepted: 06/04/2014] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Glial Derived Neurotrophic Factor (GDNF) plays an important role in the survival and differentiation of neurons. We examined 5'upstream and 3' untranslated region of the GDNF gene by PCR amplification and direct sequencing to explore the effect of alteration in the potentially regulated part of GDNF in bipolar disorder. MATERIALS AND METHODS Sixty-six patients with bipolar disorder, 27 first degree relatives of these patients and 56 healthy volunteers were screened for mutations and polymorphisms in GDNF gene. RESULTS Seven previously reported polymorphisms and additional three novel allele variants of GDNF were detected. Association test of rs2075680 C>A SNP showed significant difference between patients and healthy subjects with higher allele frequency in healthy subjects performing Chi-square test. However, there was no significant difference after multiple test corrections between groups. There were no significant differences in association test of rs2075680 C>A SNP between first degree relatives and healthy volunteers/patients. rs142426358 T>C SNP was seen only in one patient with an early age of illness onset. New T>A alterations were found in chromosome locations 5:37812784 and 5:37812782 in two male bipolar disorder patients with age of illness onset 12 and 24 years. LIMITATIONS The sample size was relatively small. DISCUSSION Our study proposes the suggestive association between polymorphisms in the potential regulatory sites of GDNF and bipolar disorder.
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Affiliation(s)
- Roghaiyeh Safari
- Department of Molecular Medicine, Dokuz Eylul University, Faculty of Medicine and Institute of Health Sciences, Inciralti, Izmir, Turkey.
| | - Zeliha Tunca
- Department of Psychiatry, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Aysegul Ozerdem
- Department of Psychiatry, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Department of Neuroscience, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Deniz Ceylan
- Department of Psychiatry, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Cigdem Eresen Yazicioglu
- Department of Medical Biology and Genetics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Meral Sakizli
- Department of Medical Biology and Genetics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
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Affiliation(s)
- Malcolm J Hopwood
- Veterans' Psychiatry Unit, Director, Brain Disorders Program; Austin Health; Heidelberg West Victoria
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22
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Gareri P, Segura-García C, Manfredi VGL, Bruni A, Ciambrone P, Cerminara G, De Sarro G, De Fazio P. Use of atypical antipsychotics in the elderly: a clinical review. Clin Interv Aging 2014; 9:1363-73. [PMID: 25170260 PMCID: PMC4144926 DOI: 10.2147/cia.s63942] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The use of atypical antipsychotic drugs in the elderly has become wider and wider in recent years; in fact, these agents have novel receptor binding profiles, good efficacy with regard to negative symptoms, and reduced extrapyramidal symptoms. However, in recent years, the use of both conventional and atypical antipsychotics has been widely debated for concerns about their safety in elderly patients affected with dementia and the possible risks for stroke and sudden death. A MEDLINE search was made using the words elderly, atypical antipsychotics, use, schizophrenia, psychosis, mood disorders, dementia, behavioral disorders, and adverse events. Some personal studies were also considered. This paper reports the receptor binding profiles and the main mechanism of action of these drugs, together with their main use in psychiatry and the possible adverse events in elderly people.
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Affiliation(s)
- Pietro Gareri
- Elderly Health Care, Azienda Sanitaria Provinciale Catanzaro, Catanzaro, Italy
| | | | | | - Antonella Bruni
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Paola Ciambrone
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Gregorio Cerminara
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | | | - Pasquale De Fazio
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
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Banerjee I, Sathian B, Chakraborty PK, Banerjee I, Roy B, Jauhari AC, Saha A. Pharmacotherapy of Bipolar Affective Disorder: A Hospital based Study from Sub Himalayan Valley of Nepal. J Clin Diagn Res 2014; 8:HC22-7. [PMID: 25121003 DOI: 10.7860/jcdr/2014/8661.4524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/06/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In Bipolar disorder the mood of the patients fluctuates between depression and mania. The main objective of the study was to find out the commonest mood stabilizers used for the treatment of Bipolar affective disorders in Western Nepal in hospitalized patients in an actual clinical set up. METHODS This was a cross-sectional study which was conducted between October 2009 and September 2010 at Psychiatric ward at Manipal teaching hospital, Pokhara, Nepal, a tertiary care hospital situated in Western Nepal. The diagnosis of the disease was based on ICD-10 (Tenth revision) Classification of mental and Behavioural disorders, Diagnostic Criteria for Research. We calculated odds ratio and their 95% confidence intervals (95% CI). p< 0.05 was considered as statistically significant. RESULTS 62.1% of the patients were less than 40 yrs, 56.3% were male, 72.4% were unemployed and 75.9% of the patients were having monthly income <10,000/month. As far as ethnicity is concerned 37.9% of the cases were Brahmin and by occupation 29.9% of the patients were students followed by housewife 25.3%, labour 17.2%, retired 13.8% respectively. Drugs and Psychotherapy [OR 1.4, 95% (CI 0.575, 3.4017)] was prescribed in age <40 years as compared to age>40 yrs. Male patients [OR 7.22, 95% (CI 0.862, 60.499)] and [OR 2.353, 95% (CI 0.857, 6.455)] received drugs by trade names and drugs not from the national drug list of Nepal as compared to females. Monthly income <10,000/month and [OR 2.8, 95% (CI 0.742, 10.56)] tendency of receiving drugs by trade names. Among the mood elevators Sodium valproate was the commonest drug to be prescribed in 51/87(58.6%) patients followed by Lithium in 30/87 (34.5%) cases and Carbamazepine in 6/87 (6.9%) cases. Sodium valproate was prescribed at 1,000 mg/day, Lithium was prescribed at 900 mg/day in and Carbamazepine was prescribed at 800 mg/day. CONCLUSION Among all the mood elevators Sodium valproate is the commonest drug prescribed for the treatment of bipolar affective disorder, recommended that there is a trend of using newer drugs like sodium valproate rather than the conventional mood stabilizers like Lithium for bipolar affective disorder in Western Development region of Nepal.
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Affiliation(s)
- Indrajit Banerjee
- Lecturer, Department of Pharmacology, Manipal College of Medical Sciences , Pokhara, Nepal
| | - Brijesh Sathian
- Assistant Professor, Department of Community Medicine, Manipal College of Medical Sciences , Pokhara, Nepal
| | | | - Indraneel Banerjee
- Post Doctorate Trainee, Department of Urology, SMS Medical College Jaipur , Rajasthan, India
| | - Bedanta Roy
- Assistant Professor, Department of Physiology, Manipal College of Medical Sciences , Pokhara, Nepal
| | | | - Archana Saha
- Professor and Head of the Department of Pharmacology, Manipal College of Medical Sciences , Pokhara, Nepal
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Ghio L, Vaggi M, Amore M, Ferrannini L, Natta W. Unmet needs and research challenges for late-life mood disorders. Aging Clin Exp Res 2014; 26:101-14. [PMID: 24078460 DOI: 10.1007/s40520-013-0149-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
Mood disorders are common and often under-recognised in older people whereby, together with the general ageing of the population, they are becoming a significant and growing public health problem worldwide. However, the need to address the problem of late life mood disorders in a real-world setting is met with a surprising lack of strong evidence in this field. Randomised clinical trials which focus on elderly mood disorders are not very common and the majority of them focus on pharmacological treatment of major depression. The aim of this study was to review first the main unmet needs and research challenges in late-life mood disorders as a basis to then review the state of the art evidence resulting from randomised clinical trials and the main critical aspects of their implementation. Comorbidity as well as polypharmacy, cognitive decline, unpredictable placebo response, and uncertainty on optimal duration of trials are some of the challenges the investigator has to address. Moreover, some methodological limitations of randomised clinical trials reduce the applicability of the results of such studies to common clinical practices and have encouraged some authors to investigate the existence of possible alternative research designs such as pragmatic randomised clinical trials.
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25
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Kerner N, Prudic J. Current electroconvulsive therapy practice and research in the geriatric population. NEUROPSYCHIATRY 2014; 4:33-54. [PMID: 24778709 PMCID: PMC4000084 DOI: 10.2217/npy.14.3] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Electroconvulsive therapy (ECT) is utilized worldwide for various severe and treatment-resistant psychiatric disorders. Research studies have shown that ECT is the most effective and rapid treatment available for elderly patients with depression, bipolar disorder and psychosis. For patients who suffer from intractable catatonia and neuroleptic malignant syndrome, ECT can be life saving. For elderly patients who cannot tolerate or respond poorly to medications and who are at a high risk for drug-induced toxicity or toxic drug interactions, ECT is the safest treatment option. Organic causes are frequently associated with late-life onset of neuropsychiatric conditions, such as parkinsonism, dementia and stroke. ECT has proven to be efficacious even when these conditions are present. During the next decade, research studies should focus on the use of ECT as a synergistic therapy, to enhance other biological and psychological treatments, and prevent symptom relapse and recurrence.
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Affiliation(s)
- Nancy Kerner
- Electroconvulsive Therapy Service & the Division of Geriatric Psychiatry, New York State Psychiatric Institute, & the College of Physicians & Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
| | - Joan Prudic
- Electroconvulsive Therapy Service & the Division of Geriatric Psychiatry, New York State Psychiatric Institute, & the College of Physicians & Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
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Riva-Posse P, Hermida AP, McDonald WM. The role of electroconvulsive and neuromodulation therapies in the treatment of geriatric depression. Psychiatr Clin North Am 2013; 36:607-30. [PMID: 24229660 DOI: 10.1016/j.psc.2013.08.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Geriatric depression is associated with increased mortality because of suicide and decreases in functional and physical health. Many elders' depression is resistant to psychotherapy and medication and can become chronic. Electroconvulsive therapy (ECT) is increasingly used in the treatment of medication-resistant or life-threatening geriatric depression. Neuromodulation therapies (subconvulsive, focal, or subconvulsive and focal) are alternatives for the management of treatment-resistant depression in the elderly. Therapies that combine both strategies could be safer but may not be as effective as ECT. This review covers the evidence on the safety and efficacy of ECT and the neuromodulation therapies in geriatric depression.
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Affiliation(s)
- Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University, 101 Woodruff Cir NE, Suite 4000, Atlanta, GA 30322, USA
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Iltis AS, Misra S, Dunn LB, Brown GK, Campbell A, Earll SA, Glowinski A, Hadley WB, Pies R, Dubois JM. Addressing risks to advance mental health research. JAMA Psychiatry 2013; 70:1363-71. [PMID: 24173618 PMCID: PMC4482112 DOI: 10.1001/jamapsychiatry.2013.2105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Risk communication and management are essential to the ethical conduct of research, yet addressing risks may be time consuming for investigators and institutional review boards may reject study designs that seem too risky. This can discourage needed research, particularly in higher-risk protocols or those enrolling potentially vulnerable individuals, such as those with some level of suicidality. Improved mechanisms for addressing research risks may facilitate much needed psychiatric research. OBJECTIVE To provide mental health researchers with practical approaches to (1) identify and define various intrinsic research risks, (2) communicate these risks to others (eg, potential participants, regulatory bodies, and society), (3) manage these risks during the course of a study, and (4) justify the risks. EVIDENCE REVIEW As part of a National Institute of Mental Health-funded scientific meeting series, a public conference and a closed-session expert panel meeting were held on managing and disclosing risks in mental health clinical trials. The expert panel reviewed the literature with a focus on empirical studies and developed recommendations for best practices and further research on managing and disclosing risks in mental health clinical trials. No institutional review board-review was required because there were no human subjects. FINDINGS Challenges, current data, practical strategies, and topics for future research are addressed for each of 4 key areas pertaining to management and disclosure of risks in clinical trials: identifying and defining risks, communicating risks, managing risks during studies, and justifying research risks. CONCLUSIONS AND RELEVANCE Empirical data on risk communication, managing risks, and the benefits of research can support the ethical conduct of mental health research and may help investigators better conceptualize and confront risks and to gain institutional review board-approval.
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Affiliation(s)
- Ana S Iltis
- Center for Bioethics, Health, and Society and Department of Philosophy, Wake Forest University, Winston-Salem, North Carolina
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Abstract
BACKGROUND Lithium is used both in bipolar disorder and as augmentation in treatment-resistant unipolar depression. Long-term treatment is often indicated. Pharmacokinetic and pharmacodynamic changes in older age, as well as increasing comorbidities and polypharmacy, could result in instability of serum lithium concentrations. In this study, several parameters, considered proxy for instability, were compared between age groups. These parameters were derived from studies involving oral anticoagulants. METHODS A retrospective study (1995-2004) was conducted using serum lithium concentrations from the laboratories of 3 hospitals in the Netherlands; 759 patients treated with lithium, 40 years or older, with at least 2 years' follow-up were identified. They were divided into 4 age groups: 40-49, 50-59, 60-69, and 70+ years; the youngest group was used as a reference group. The variance growth rate and percentage of time below, in, and above treatment range are all proxies for instability. They were analyzed between the age categories. RESULTS There was no significant difference for these variables between the reference group and the older age groups. In a subgroup of 454 patients, the parameters considered as proxy for instability during titration, number of days and number of serum lithium concentration measurements during titration, were evaluated; no significant difference was found between the age groups. In a small group of 117 patients, titration and maintenance treatment for at least 2 years could be analyzed separately. Also in this group, there was no difference between the age groups. CONCLUSIONS Age is not a determinant of serum lithium concentration instability. Therefore, age is not a reason to not initiate or discontinue lithium therapy.
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Sheeran T, Greenberg RL, Davan LA, Dealy JA, Young RC, Bruce ML. A descriptive study of older bipolar disorder residents living in New York City's adult congregate facilities. Bipolar Disord 2012; 14:756-63. [PMID: 23107221 PMCID: PMC4098752 DOI: 10.1111/bdi.12008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Much of the research on geriatric bipolar disorder is from outpatient populations or epidemiological surveys with small samples. In contrast, in this study a descriptive analysis was conducted of geriatric and younger adult residents with bipolar disorder or mania in non-clinical adult congregate facilities (ACFs) in the greater New York City region. METHODS A total of 2602 ACF residents were evaluated in 19 facilities, across multiple demographic and health domains. Within this sample, 200 residents had chart diagnoses of bipolar disorder or mania. Among these, 50 geriatric residents (age ≥ 60) were compared to 50 younger adult residents (age < 50) on a number of demographic and health measures. RESULTS Based on chart diagnoses, the overall prevalence of bipolar disorder was 7.8%. Compared to other studies of outpatient, epidemiological, and census samples, both older and younger residents with bipolar disorder had higher rates of cognitive impairment, impairment in executive functioning, vision impairment, and proportion of residents who had never been married. The younger group also had higher rates of obesity and the elderly group had a greater proportion of residents without high-school education. Both age groups had rates of lithium or valproate use comparable to those found in outpatient studies. Comparing the two age groups, the elderly sample had lower overall cognitive and executive functioning, and was using a larger number of medication classes than the younger group. The elderly group also had a larger proportion of residents who were separated/divorced or widowed compared to the younger group, which had higher rates of never-married residents. CONCLUSIONS Overall, both age groups had relatively high rates of bipolar disorder, with significant cognitive impairment, medical burden, obesity, mental health service use, and lower education levels, as compared to outpatient, epidemiological, and census samples. Of note was the significant cognitive impairment across age groups.
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Affiliation(s)
- Thomas Sheeran
- Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI 02903, USA.
| | - Rebecca L Greenberg
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Laura A Davan
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Jennifer A Dealy
- Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI
| | - Robert C Young
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Martha L Bruce
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY, USA
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Allan CL, Ebmeier KP. Prophylaxis and treatment of bipolar disorder in older adults. J Psychiatry Neurosci 2012; 37:E7-8. [PMID: 22709480 PMCID: PMC3380100 DOI: 10.1503/jpn.120019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Charlotte L Allan
- Department of Psychiatry University of Oxford Warneford Hospital Oxford, United Kingdom
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van Melick EJM, Wilting I, Souverein PC, Egberts TCG. Differences in Lithium Use Patterns in the Netherlands: Comparing Middle-Aged and Older Patients in a Database Study. ACTA ACUST UNITED AC 2012; 10:193-200. [DOI: 10.1016/j.amjopharm.2012.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/01/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
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Connolly KR, Thase ME. The clinical management of bipolar disorder: a review of evidence-based guidelines. Prim Care Companion CNS Disord 2012; 13:10r01097. [PMID: 22132354 DOI: 10.4088/pcc.10r01097] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To discuss the criteria used to diagnose the mood episodes that constitute bipolar disorder, the approach to the differential diagnosis of these presentations, and the evidence-based treatments that are currently available. DATA SOURCES A search for evidence-based guidelines for the diagnosis and treatment of adults with bipolar disorder was performed on May 5, 2010, using the National Guideline Clearinghouse database, the Agency for Healthcare Research and Quality Evidence Reports database, and the Cochrane Database of Systematic Reviews. In addition, a clinical query of the PubMed database (completed March 1, 2010) and searches of drug manufacturers' Web sites (for unpublished trials) were performed to identify randomized, controlled trials and meta-analyses evaluating strategies to treat resistant depression. STUDY SELECTION Guidelines were selected based on data from randomized, controlled trials; meta-analyses; and well-conducted naturalistic trials that were published since 2005. DATA EXTRACTION Four evidence-based treatment guidelines for bipolar disorder were included. Three were published in 2009: those put forth as part of an Australian project, those of the British Association for Psychopharmacology, and those produced by the International Society for Bipolar Disorders and the Canadian Network for Mood and Anxiety Treatments. The most recent US guidelines are that of the Texas Implementation of Medication Algorithms project, last updated in 2005. DATA SYNTHESIS Recommendations from all 4 guidelines were reviewed and are presented with a focus on using them to improve clinical care. The recommendations with the most agreement and highest level of clinical evidence were as follows: (1) mania should be treated first-line with lithium, divalproex, or an atypical antipsychotic medication; (2) mixed episodes should be treated first-line with divalproex or an atypical antipsychotic; (3) bipolar depression should be treated with quetiapine, olanzapine/fluoxetine combination, or lamotrigine; and (4) all patients should be offered group or individual psychoeducation. Additionally, recommendations for therapeutic drug monitoring are presented due to their importance for patient safety, particularly for the primary care physician, although these are based on consensus guidelines. CONCLUSIONS Bipolar disorder is a lifelong illness that is complicated by high comorbidity and risk of poor health outcomes, making the primary care physician's role vital in improving patient quality of life. The management of acute mood episodes should focus first on safety, should include psychiatric consultation as soon as possible, and should begin with an evidence-based treatment that may be continued into the maintenance phase. Long-term management focuses on maintenance of euthymia, requires ongoing medication, and may benefit from adjunctive psychotherapy.
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Affiliation(s)
- Kevin R Connolly
- Department of Behavioral Health, Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA.
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Bhalerao S, Seyfried LS, Kim HM, Chiang C, Kavanagh J, Kales HC. Mortality risk with the use of atypical antipsychotics in later-life bipolar disorder. J Geriatr Psychiatry Neurol 2012; 25:29-36. [PMID: 22467844 PMCID: PMC4216676 DOI: 10.1177/0891988712436687] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In recent years, concerns about the use of antipsychotic medications in dementia have grown. There is limited data on mortality risk of atypical antipsychotics for other psychiatric disorders of later life such as bipolar disorder. METHODS Data were derived from the national Department of Veterans Affairs registries for older patients with bipolar disorder (≥65 years) with a new start of an atypical antipsychotic (risperidone, olanzapine, or quetiapine) or valproic acid and derivatives during fiscal years 2001-2008. Six-month mortality rates were compared for individual drug groups. RESULTS The sample included 4717 patients. The risperidone cohort had the highest mortality rate (11.8 per 100 person-years) with the quetiapine and valproic acid cohorts having the lowest (5.3 and 4.6 per 100 person-years, respectively). Various methods to adjust for baseline differences including propensity models showed similar patterns. CONCLUSIONS Among older patients with bipolar disorder, there may be differences in mortality risks among individual antipsychotic agents.
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Affiliation(s)
- Sachin Bhalerao
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Lisa S. Seyfried
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Hyungjin Myra Kim
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Veterans Affairs, Center for Clinical Management Research (CCMR), Ann Arbor, Michigan,Serious Mental Illness Treatment, Resource, and Evaluation Center (SMITREC), Ann Arbor, Michigan,Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - Claire Chiang
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Veterans Affairs, Center for Clinical Management Research (CCMR), Ann Arbor, Michigan,Serious Mental Illness Treatment, Resource, and Evaluation Center (SMITREC), Ann Arbor, Michigan
| | - Janet Kavanagh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Helen C. Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Veterans Affairs, Center for Clinical Management Research (CCMR), Ann Arbor, Michigan,Serious Mental Illness Treatment, Resource, and Evaluation Center (SMITREC), Ann Arbor, Michigan
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Cruz LPD, Miranda PM, Vedana KGG, Miasso AI. Medication therapy: adherence, knowledge and difficulties of elderly people from bipolar disorder. Rev Lat Am Enfermagem 2012; 19:944-52. [PMID: 21876947 DOI: 10.1590/s0104-11692011000400013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 11/22/2010] [Indexed: 12/21/2022] Open
Abstract
This study aimed to verify the adherence, knowledge and the difficulties of elderly patients with Bipolar Affective Disorder (BAD) in relation to the prescribed pharmacological therapy for the control of this disorder. The study included 17 elderly patients with BAD treated at a Mental Health Center. Semi-structured interviews were conducted and scales were applied. The data were analyzed using a quali-quantitative approach. A low level of adherence to the pharmacological treatment and a deficit in knowledge in relation to the medication were identified, especially regarding the dose and frequency of administration. Among the difficulties inherent to the pharmacotherapy, the obligation of polypharmacotherapy, the desire to quit the pharmacological treatment, limitations in the self-administration of the medication, collateral effects, and doubts about the need for the medication were related. Investment is needed in educational activities and in the promotion of adherence that address the difficulties experienced by elderly people with BAD in the following of the pharmacotherapy in order to ensure safety in the medication therapy.
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Affiliation(s)
- Ligiane Paula da Cruz
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, SP, Brazil.
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Mahmoud F, Tampi RR. Valproic Acid–Induced Parkinsonism in the Elderly: A Comprehensive Review of the Literature. ACTA ACUST UNITED AC 2011; 9:405-12. [DOI: 10.1016/j.amjopharm.2011.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2011] [Indexed: 10/16/2022]
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D'Souza R, Rajji TK, Mulsant BH, Pollock BG. Use of lithium in the treatment of bipolar disorder in late-life. Curr Psychiatry Rep 2011; 13:488-92. [PMID: 21847537 DOI: 10.1007/s11920-011-0228-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Lithium is the oldest and still one of the most frequently prescribed mood stabilizers in the treatment of bipolar disorder. Nonetheless, the evidence for lithium efficacy in older patients with bipolar disorder is almost entirely extrapolated from younger adult patients. Here we review the literature on lithium in older patients with bipolar disorder, concentrating on the past 3 years. A definitive study demonstrating the efficacy and safety of lithium in older patients with bipolar disorder is still missing. However, several lines of indirect evidence suggest that it is beneficial and advantageous over other mood stabilizers in the acute and maintenance treatment of late-life bipolar disorder. In addition, lithium may have unique properties as a regenerative therapeutic with specific benefits in reducing the cognitive impairment and suicide rates associated with bipolar disorder across the adult lifespan. Aging-associated pharmacokinetic and pharmacodynamic changes as well as increased rates of medical comorbidities and polypharmacy predispose older patients to a higher risk of lithium toxicity. Careful monitoring and adjustment of lithium dosage is especially important in older adults to minimize the risk of toxicity.
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Affiliation(s)
- Ramsey D'Souza
- Division of Geriatric Psychiatry, University of Toronto, and Geriatric Mental Health Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada.
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Haller S, Xekardaki A, Delaloye C, Canuto A, Lövblad KO, Gold G, Giannakopoulos P. Combined analysis of grey matter voxel-based morphometry and white matter tract-based spatial statistics in late-life bipolar disorder. J Psychiatry Neurosci 2011; 36:391-401. [PMID: 21284917 PMCID: PMC3201993 DOI: 10.1503/jpn.100140] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Previous magnetic resonance imaging (MRI) studies in young patients with bipolar disorder indicated the presence of grey matter concentration changes as well as microstructural alterations in white matter in various neocortical areas and the corpus callosum. Whether these structural changes are also present in elderly patients with bipolar disorder with long-lasting clinical evolution remains unclear. METHODS We performed a prospective MRI study of consecutive elderly, euthymic patients with bipolar disorder and healthy, elderly controls. We conducted a voxel-based morphometry (VBM) analysis and a tract-based spatial statistics (TBSS) analysis to assess fractional anisotropy and longitudinal, radial and mean diffusivity derived by diffusion tensor imaging (DTI). RESULTS We included 19 patients with bipolar disorder and 47 controls in our study. Fractional anisotropy was the most sensitive DTI marker and decreased significantly in the ventral part of the corpus callosum in patients with bipolar disorder. Longitudinal, radial and mean diffusivity showed no significant between-group differences. Grey matter concentration was reduced in patients with bipolar disorder in the right anterior insula, head of the caudate nucleus, nucleus accumbens, ventral putamen and frontal orbital cortex. Conversely, there was no grey matter concentration or fractional anisotropy increase in any brain region in patients with bipolar disorder compared with controls. LIMITATIONS The major limitation of our study is the small number of patients with bipolar disorder. CONCLUSION Our data document the concomitant presence of grey matter concentration decreases in the anterior limbic areas and the reduced fibre tract coherence in the corpus callosum of elderly patients with long-lasting bipolar disorder.
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Affiliation(s)
- Sven Haller
- Service neuro-diagnostique et neuro-interventionnel DISIM, University Hospitals of Geneva, Geneva, Switzerland.
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Kastenschmidt EK, Kennedy GJ. Depression and Anxiety in Late Life: Diagnostic Insights and Therapeutic Options. ACTA ACUST UNITED AC 2011; 78:527-45. [DOI: 10.1002/msj.20266] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Azorin JM, Kaladjian A, Adida M, Fakra E. Late-onset bipolar illness: the geriatric bipolar type VI. CNS Neurosci Ther 2011; 18:208-13. [PMID: 22070456 DOI: 10.1111/j.1755-5949.2011.00255.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In parallel to considerable progress in understanding and treatment of bipolarity and despite growing interest in old age psychiatry, late-onset bipolar illness (LOBI) has remained relatively understudied so far, probably in reason of its complexity. To update available data, a systematic review was conducted, focusing on the main issues addressed in literature in regard to this topic. In addition to data on epidemiology, clinical features and treatment, five main issues could be identified: LOBI as secondary disorder, LOBI as expression of a lower vulnerability to the disease, LOBI as subform of pseudodementia, LOBI as risk factor for developing dementia, and LOBI as bipolar type VI (bipolarity in the context of dementia like processes). Levels of available evidence were found to vary according to the addressed issue. Although the concept of bipolar type VI could be criticized for subsuming under one single heading all the four other issues, this concept may be of pragmatic value in helping clinicians to orientate both diagnosis process and treatment decisions. Among others, the question as to whether some forms of bipolar type VI could constitute a special risk factor for developing dementia deserves further investigation. More studies are also needed to better disentangle the effects of age at onset from those of age itself.
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Affiliation(s)
- Jean-Michel Azorin
- Pôle Universitaire de Psychiatrie-Solaris, Hôpital Sainte-Marguerite, Cedex, France.
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Abstract
Because the elderly are the fastest growing segment of the population, the number of older adults with bipolar disorder is increasing. Geriatric bipolar disorder is relatively rare, with an estimated lifetime prevalence of 0.5% to 1%, although approximately 4% to 17% of older patients in clinical psychiatric settings have bipolar disorder. Bipolar elders are disproportionately affected by medical burden. Given the complex nature of this disorder, comorbidity, and behavioral disturbances, various interventions may be indicated, including pharmacotherapies, electroconvulsive therapy, psychotherapies, and integrated care models. Additional research is needed to better understand the epidemiology, phenomenology, and treatment of geriatric bipolar disorder.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Davitt JK, Gellis ZD. Integrating mental health parity for homebound older adults under the medicare home health care benefit. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2011; 54:309-324. [PMID: 21462061 DOI: 10.1080/01634372.2010.540075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.
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Affiliation(s)
- Joan K Davitt
- School of Social Policy & Practice; and New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Monteschi M, Vedana KGG, Miasso AI. Terapêutica medicamentosa: conhecimento e dificuldades de familiares de pessoas idosas com transtorno afetivo bipolar. TEXTO & CONTEXTO ENFERMAGEM 2010. [DOI: 10.1590/s0104-07072010000400014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Este estudo descritivo quali-quantitativo teve como objetivo verificar o grau de conhecimento e dificuldades do familiar do idoso com Transtorno Afetivo Bipolar referentes ao tratamento medicamentoso prescrito para o paciente. Participaram do estudo 17 familiares de idosos com Transtorno Afetivo Bipolar atendidos em um Núcleo de Saúde Mental. Para coleta de dados empregou-se a entrevista semiestruturada e aplicação de escala. Identificou-se baixo nível de conhecimento dos familiares, especialmente sobre doses e frequência dos medicamentos prescritos. Dentre as dificuldades relacionadas ao tratamento medicamentoso dos pacientes, relatadas pelos familiares, destacaram-se a ambiguidade em relação à avaliação dos benefícios do medicamento, não aderência dos pacientes ao medicamento, sobrecarga relacionada aos cuidados referentes aos medicamentos, tratamento inadequado, preocupação com o acesso ao medicamento e utilização de bebida alcoólica pelo paciente. É imperativa a necessidade de ações educativas junto à família e sua inclusão na assistência oferecida ao paciente, como colaboradora e alvo das intervenções.
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Shulman KI. Lithium for older adults with bipolar disorder: Should it still be considered a first-line agent? Drugs Aging 2010; 27:607-15. [PMID: 20658789 DOI: 10.2165/11537700-000000000-00000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of lithium carbonate for the treatment of bipolar disorder in older adults is decreasing at a significant rate. This change in prescription pattern is occurring at a time when all evidence-based treatment guidelines and systematic reviews still recommend lithium as a first-line treatment for bipolar disorder. Despite having the strongest evidence base for effectiveness, lithium does pose significant concerns in the older population, including the risk of drug interactions that cause toxicity associated with decreased creatinine clearance. The evidence for lithium's impact on chronic renal disease is still controversial and is reviewed in this article. Mixed evidence exists regarding the impact of lithium on suicide risk, although there is a consensus that it does have protective properties through its mood-stabilizing effect. Because of the very limited research base regarding the use of lithium in old age, guidelines for dosing and maintenance of serum concentrations are not well established, and this may be leading to increased episodes of lithium toxicity. At the same time that these legitimate concerns about lithium are being highlighted, evidence has accumulated that suggests that lithium may have neuroprotective properties. Its action of inhibiting the enzyme glycogen synthase kinase-3 may be responsible in part for a decrease in the induction of amyloid beta peptide and hyperphosphorylated tau protein, which have been implicated in the development of Alzheimer's disease. Very little evidence supports use of alternatives to lithium such as other mood-stabilizing agents, including atypical antipsychotics, in older adults. Thus, before we abandon lithium as a first-line agent, we should ensure that the guidelines for lithium treatment are safe, practical and effective. Newer agents must be appropriately tested in older adults before replacing this longstanding first-line treatment for bipolar disorder.
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Affiliation(s)
- Kenneth I Shulman
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada
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&NA;. Consider the long-term implications of treatment and the needs of the individual when selecting treatments for bipolar disorder. DRUGS & THERAPY PERSPECTIVES 2010. [DOI: 10.2165/11205410-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Anticonvulsant use, bipolar disorder, and risk of fracture among older adults in the Veterans Health Administration. Am J Geriatr Psychiatry 2010; 18:245-55. [PMID: 20224520 DOI: 10.1097/jgp.0b013e3181bf9ebd] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the association between anticonvulsant use and fracture risk among older patients, including those with bipolar disorder (BD), an indicated condition for treatment with this class of medications. DESIGN A prospective cohort study with 4.5 years of follow-up analyzed using both Cox proportional hazards modeling and propensity score techniques. SETTING National sample selected from Veterans Health Administration records. PARTICIPANTS A representative sample of 67,387 Veterans Administration patients aged 50 years and older selected in fiscal year 2002 and followed until 2006, including 29,029 with a diagnosis of BD identified from the Veterans Administration National Psychosis Registry. Pharmacy records identified 19,635 patients who had ever used anticonvulsant medications. MEASUREMENTS Incident fracture at any site and incident hip fracture indicated by administrative data. RESULTS There were 4,367 fractures over the 4.5-year study period. Approximately two-thirds of patients with BD were prescribed anticonvulsants, and diagnosis of BD was associated with 20% increased risk of fracture independent of anticonvulsant use. Cumulative incidence of fracture was higher among anticonvulsant users relative to never users (35.7 per 1,000 versus 14.2 per 1,000 person-years). In fully adjusted models, anticonvulsant use was associated with over twofold greater risk of fracture (hazard ratio: 2.42, 95% confidence interval: 2.23-2.633). Current use was associated with the greater risk of fracture relative to former use. Duration of anticonvulsant use was significantly associated with increased fracture risk in a graded, nonlinear manner. CONCLUSIONS Use of anticonvulsants is associated with increased risk of fracture among older patients with BD and among those without serious mental illness.
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Malhi GS, Adams D, Cahill CM, Dodd S, Berk M. The management of individuals with bipolar disorder: a review of the evidence and its integration into clinical practice. Drugs 2010; 69:2063-101. [PMID: 19791827 DOI: 10.2165/11318850-000000000-00000] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bipolar disorder is a common, debilitating, chronic illness that emerges early in life and has serious consequences such as long-term unemployment and suicide. It confers considerable functional disability to the individual, their family and society as a whole and yet it is often undetected, misdiagnosed and treated poorly. In the past decade, many new treatment strategies have been trialled in the management of bipolar disorder with variable success. The emerging evidence, for pharmacological agents in particular, is promising but when considered alone does not directly translate to real-world clinical populations of bipolar disorder. Data from drug trials are largely based on findings that identify differences between groups determined in a time-limited manner, whereas clinical management concerns the treatment of individuals over the life-long course of the illness. Considering the findings in the context of the individual and their particular needs perhaps best bridges the gap between the evidence from research studies and their application in clinical practice. Specifically, only lithium and valproate have moderate or strong evidence for use across all three phases of bipolar disorder. Anticonvulsants, such as lamotrigine, have strong evidence in maintenance; whereas antipsychotics largely have strong evidence in acute mania, with the exception of quetiapine, which has strong evidence in bipolar depression. Maintenance data for antipsychotics is emerging but at present remains weak. Combinations have strong evidence in acute phases of illness but maintenance data is urgently needed. Conventional antidepressants only have weak evidence in bipolar depression and do not have a role in maintenance therapy. Therefore, this paper summarizes the efficacy data for treating bipolar disorder and also applies clinical considerations to these data when formulating recommendations for the management of bipolar disorder.
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Affiliation(s)
- Gin S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, New South Wales, Australia.
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Delaloye C, Moy G, Baudois S, de Bilbao F, Remund CD, Hofer F, Ragno Paquier C, Campos L, Weber K, Gold G, Moussa A, Meiler CC, Giannakopoulos P. Cognitive features in euthymic bipolar patients in old age. Bipolar Disord 2009; 11:735-43. [PMID: 19719786 DOI: 10.1111/j.1399-5618.2009.00741.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Studies of cognition in bipolar disorder (BD) have reported impairments in processing speed, working memory, episodic memory, and executive function, but they have primarily focused on young and middle-aged adults. In such studies, the severity of cognitive deficits increases with the duration of illness. Therefore, one would expect more pronounced deficits in patients with longstanding BD. The first aim of the present study was to determine the pattern and the magnitude of cognitive impairment in older euthymic BD patients. The second aim was to explore the interrelationship between these cognitive deficits and determine whether they reflect a single core impairment or the co-occurrence of independent cognitive deficits. METHODS Twenty-two euthymic elderly BD patients and 22 controls, matched for gender, age, and education, underwent a comprehensive neuropsychological assessment. RESULTS Compared to controls, BD patients had significantly reduced performance in processing speed, working memory, verbal fluency, and episodic memory, but not in executive function. Hierarchical regression analyses showed that verbal fluency and working memory impairments were fully mediated by changes in processing speed. This was not the case for the episodic memory dysfunction. CONCLUSION The cognitive profile in older euthymic BD cases is similar to the one described in younger BD cohorts. Our results further suggest that impaired processing speed plays a major role in the cognitive changes observed in BD patients except for deficits in episodic memory, thus providing strong evidence that processing speed and episodic memory are two core deficits in elderly BD patients.
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Affiliation(s)
- Christophe Delaloye
- Division of Geriatric Psychiatry, University Hospitals of Geneva, Chêne-Bourg, Switzerland
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Chemali Z, Chahine LM, Fricchione G. The use of selective serotonin reuptake inhibitors in elderly patients. Harv Rev Psychiatry 2009; 17:242-53. [PMID: 19637073 DOI: 10.1080/10673220903129798] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Depression is common among the elderly, and several factors need to be taken into account in selecting the appropriate antidepressant in this age group. Various physiologic changes occur in individuals as they age, potentially leading to changes in the pharmacodynamic and pharmacokinetic properties of drugs in elderly individuals. The efficacy of various medications, their side-effect profiles, and the potential for drug-drug interactions may differ in older patients compared to younger ones. The selective serotonin reuptake inhibitors (SSRIs), which are seen as being among the first-line agents for treatment of depression in elderly patients, have been shown to be effective but carry with them side effects and drug-drug interactions that warrant special attention when these medications are prescribed to older individuals. This review focuses on the pharmacology of SSRIs in elderly patients and on practical issues related to using these medications.
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