Psychiatric disorders in older women

Treatment of bipolar disorders in older adults: a review

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.

Older women's experiences of depression: a hermeneutic phenomenological study

This hermeneutic phenomenological study, informed by Max van Manen and Martin Heidegger, describes what it is like for four older women to live with depression. Each participant was interviewed up to three times. Interviews were semi-structured, audiotaped and transcribed verbatim. Data were analysed using van Manen's methodological themes and Heidegger's philosophical concepts of Being-in-the-world and Being-with-others. The themes that emerged were: self-loathing; being overwhelmed by the feelings; hiding from the world; the struggle of everyday life; Being-alone; misinterpreting self and other people; the stigma of mental illness - society and self; and seeking understanding from other people. The findings revealed that depression had a major effect on the women's beliefs about themselves, resulting in a self-loathing and a feeling of failure. The participants described how their self-loathing caused them to believe that other people thought badly of them, which led to their withdrawal. Their inability to connect contributed to them feeling alone and isolated. These women were more able to talk to other people when they were met with understanding. This has implications for the therapeutic nurse-patient relationship, which is fundamental to mental health nursing, because the relationship should be based upon an understanding of the patient's world.

Rehabilitation programs for elderly women inpatients with schizophrenia

This study aims to describe rehabilitation and resocialization methods we believe to be appropriate for application to female patients with schizophrenia, in a psychiatric unit with a predominantly older population. We briefly describe the unit and the interventions used as an example of the proposed rehabilitation and resocialization methods applied. The article provides an overview to guide accurate intervention, particularly in inpatient women, in different types of cognitive impairment under the broad category of schizophrenia. Our clinical approach includes a token economy approach, cognitive remediation therapy, and social skills training. The token economy intervention is particularly directed to patients that present with a high mental deterioration and/or debility. Cognitive remediation training is applicable to subjects with both cognitive and social dysfunction, but that do not possess signs of an organic cerebral illness or of substance abuse. Social skills training can be the third step to resocialization, training verbal and nonverbal communication competencies.

Women, Aging, and Schizophrenia

Schizophrenia is a psychiatric disorder of unknown etiology that typically has an onset in early adulthood and persists for the remainder of the lifespan. For most affected individuals, the illness is recurrent with psychotic symptoms that tend to be episodic in nature. The illness has pervasive and disruptive effects on many life domains; for example, women with schizophrenia are less likely to marry, bear children, and raise their own children than are women in the general population. The age of onset of schizophrenia is later on average in women then men, and women are over-represented among those who develop the illness after the age of 45. Among younger patients with schizophrenia, women tend to have less severe symptoms than men and better outcomes; however, there are fewer gender differences among older patients with schizophrenia. Older women with schizophrenia are vulnerable to problems of both schizophrenia and aging. Schizophrenia symptoms typically continue in later years and include ongoing psychotic symptoms. Problems of aging such as cognitive decline and chronic medical conditions may be exacerbated by schizophrenia and the disorder is associated with premature mortality. Older women with schizophrenia are at risk for neglect of psychiatric and other health needs that are further compounded by limited social support and low socioeconomic status. More research and clinical attention is needed to the problems of older women with schizophrenia.

Bipolar disorder in late life: future directions in efficacy and effectiveness research

There is a dearth of knowledge regarding the diagnosis and treatment of bipolar disorder in late life. Based on a review of the current research on bipolar disorder in late life, emerging areas of research were identified: 1) methodological challenges in diagnosing bipolar disorder; 2) a lack of guidelines for the treatment of bipolar disorder in late life; 3) increased prevalence of general medical comorbidities; and 4) a need to improve access to care and social support services. The current literature regarding bipolar disorder in late life suggests the need for more rigorous studies on accuracy in diagnoses, etiology and risk factors, and efficacy studies on pharmacotherapy treatment options. However, effectiveness studies that focus on translating research into practice also are needed, particularly strategies to monitor and improve the quality of care in routine settings and better coordinated medical, psychiatric, and social services for older adults with bipolar disorder.