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Klaus F, Ng HX, Barbosa IG, Beunders A, Briggs F, Burdick KE, Dols A, Forlenza O, Gildengers A, Millett C, Mulsant BH, Orhan M, Rajji TK, Rej S, Sajatovic M, Sarna K, Schouws S, Sutherland A, Teixeira AL, Yala JA, Eyler LT. Cognition in older age bipolar disorder: An analysis of archival data across the globe. J Affect Disord 2024; 355:231-238. [PMID: 38548199 DOI: 10.1016/j.jad.2024.03.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/27/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Cognitive deficits in bipolar disorder (BD) impact functioning and are main contributors to disability in older age BD (OABD). We investigated the difference between OABD and age-comparable healthy comparison (HC) participants and, among those with BD, the associations between age, global cognitive performance, symptom severity and functioning using a large, cross-sectional, archival dataset harmonized from 7 international OABD studies. METHODS Data from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) database, spanning various standardized measures of cognition, functioning and clinical characteristics, were analyzed. The sample included 662 euthymic to mildly symptomatic participants aged minimum 50years (509 BD, 153 HC), able to undergo extensive cognitive testing. Linear mixed models estimated associations between diagnosis and global cognitive performance (g-score, harmonized across studies), and within OABD between g-score and severity of mania and depressive symptoms, duration of illness and lithium use and of global functioning. RESULTS After adjustment for study cohort, age, gender and employment status, there was no significant difference in g-score between OABD and HC, while a significant interaction emerged between employment status and diagnostic group (better global cognition associated with working) in BD. Within OABD, better g-scores were associated with fewer manic symptoms, higher education and better functioning. LIMITATIONS Cross-sectional design and loss of granularity due to harmonization. CONCLUSION More research is needed to understand heterogenous longitudinal patterns of cognitive change in BD and understand whether particular cognitive domains might be affected in OABD in order to develop new therapeutic efforts for cognitive dysfunction OABD.
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Affiliation(s)
- Federica Klaus
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Hui Xin Ng
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Izabela G Barbosa
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alexandra Beunders
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Amsterdam, the Netherlands; Amsterdam UMC, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Farren Briggs
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Annemieke Dols
- Amsterdam UMC, Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Orestes Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Hospital, USA
| | - Caitlin Millett
- Institute of Behavioral Science, The Feinstein Institutes of Medical Research, New York, USA
| | - Benoit H Mulsant
- Department of Psychiatry, Center for Addiction & Mental Health, University of Toronto, Toronto, Canada
| | - Melis Orhan
- Institute of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | - Tarek K Rajji
- Department of Psychiatry, Center for Addiction & Mental Health, University of Toronto, Toronto, Canada
| | - Soham Rej
- Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine (MS), University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine (MS), University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sigfried Schouws
- GZZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Amsterdam, the Netherlands
| | - Ashley Sutherland
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
| | - Antonio L Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas/McGovern Medical School, Houston, TX, USA; Faculdade Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil
| | - Joy A Yala
- Case Western Reserve University School of Medicine (MS), University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
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2
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Dols A, Sajatovic M. What is really different about older age bipolar disorder? Eur Neuropsychopharmacol 2024; 82:3-5. [PMID: 38325230 DOI: 10.1016/j.euroneuro.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine (MS), University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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3
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Sajatovic M, Rej S, Almeida OP, Altinbas K, Balanzá-Martínez V, Barbosa IG, Beunders AJM, Blumberg HP, Briggs FBS, Dols A, Forester BP, Forlenza OV, Gildengers AG, Jimenez E, Klaus F, Lafer B, Mulsant B, Mwangi B, Nunes PV, Olagunju AT, Oluwaniyi S, Orhan M, Patrick RE, Radua J, Rajji T, Sarna K, Schouws S, Simhandl C, Sekhon H, Soares JC, Sutherland AN, Teixeira AL, Tsai S, Vidal-Rubio S, Vieta E, Yala J, Eyler LT. Bipolar symptoms, somatic burden and functioning in older-age bipolar disorder: A replication study from the global aging & geriatric experiments in bipolar disorder database (GAGE-BD) project. Int J Geriatr Psychiatry 2024; 39:e6057. [PMID: 38511929 DOI: 10.1002/gps.6057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/10/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project pools archival datasets on older age bipolar disorder (OABD). An initial Wave 1 (W1; n = 1369) analysis found both manic and depressive symptoms reduced among older patients. To replicate this finding, we gathered an independent Wave 2 (W2; n = 1232, mean ± standard deviation age 47.2 ± 13.5, 65% women, 49% aged over 50) dataset. DESIGN/METHODS Using mixed models with random effects for cohort, we examined associations between BD symptoms, somatic burden and age and the contribution of these to functioning in W2 and the combined W1 + W2 sample (n = 2601). RESULTS Compared to W1, the W2 sample was younger (p < 0.001), less educated (p < 0.001), more symptomatic (p < 0.001), lower functioning (p < 0.001) and had fewer somatic conditions (p < 0.001). In the full W2, older individuals had reduced manic symptom severity, but age was not associated with depression severity. Age was not associated with functioning in W2. More severe BD symptoms (mania p ≤ 0.001, depression p ≤ 0.001) were associated with worse functioning. Older age was significantly associated with higher somatic burden in the W2 and the W1 + W2 samples, but this burden was not associated with poorer functioning. CONCLUSIONS In a large, independent sample, older age was associated with less severe mania and more somatic burden (consistent with previous findings), but there was no association of depression with age (different from previous findings). Similar to previous findings, worse BD symptom severity was associated with worse functioning, emphasizing the need for symptom relief in OABD to promote better functioning.
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Affiliation(s)
- Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Soham Rej
- Jewish General Hospital/Lady Davis Hospital, McGill University, Montreal, Québec, Canada
| | - Osvaldo P Almeida
- University of Western Australia, Perth, Western Australia, Australia
| | - Kursat Altinbas
- Selçuk University Medical Faculty, Department of Psychiatry, Mazhar Osman Mood Clinic, Konya, Turkey
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
| | - Izabela G Barbosa
- Mental Health Department, Medicine School, Minas Gerais University, Belo Horizonte, Brazil
| | - Alexandra J M Beunders
- GGZ inGeest, Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Annemiek Dols
- Amsterdam UMC, VU University, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, ISCIII Barcelona, Barcelona, Catalonia, Spain
| | - Federica Klaus
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Beny Lafer
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Houston, Houston, Texas, USA
| | - Paula Villela Nunes
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | | | - Melis Orhan
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Regan E Patrick
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Tarek Rajji
- Department of Psychiatry, Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
| | - Christian Simhandl
- Medical Faculty, Bipolar Center Wiener Neustadt, Sigmund Freud University Vienna, Wien, Austria
| | - Harmehr Sekhon
- Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas/McGovern Medical School, Houston, Texas, USA
| | - Ashley N Sutherland
- Department of Psychiatry, University of California, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
| | - Antonio L Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas/McGovern Medical School, Houston, Texas, USA
- Faculdade Santa Casa BH, Belo Horizonte, Brazil
| | - Shangying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, ISCIII Barcelona, Barcelona, Catalonia, Spain
| | - Joy Yala
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
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4
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Vahapoğlu B, Aksoy Poyraz C, Özdemir A. Psychosocial Impairment in Older Patients With Bipolar I Disorder. J Psychiatr Pract 2024; 30:147-156. [PMID: 38526403 DOI: 10.1097/pra.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND The goal of this study was to assess psychosocial functioning in older patients with bipolar I disorder compared with healthy subjects and to identify the psychopathological factors associated with poor functioning in patients. METHODS We recruited 68 euthymic patients with bipolar I disorder from the outpatient unit and 89 healthy controls who were older than 50 years of age. In addition to clinical variables, we used other standardized measures, including the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Functional Assessment Short Test, and the Montreal Cognitive Assessment. RESULTS Older patients with bipolar I disorder had poorer psychosocial functioning in general and in the domains of occupation, autonomy, and cognition than the healthy controls on the basis of previously defined Functional Assessment Short Test cutoff scores. We found that 35.3% (95% CI: 23%-47%) of the patients did not have clinically significant functional impairment, 38.2% (95% CI: 26%-50%) had mild impairment, and 26.5% (95% CI: 16%-37%) had moderate impairment. Depressive symptoms and impaired cognition were associated with poor overall functioning. CONCLUSIONS The level of psychosocial functioning was heterogeneous among the patients. Subsyndromal depressive symptoms, even at low levels, and impaired cognition predicted poor functioning in euthymic middle-aged and older patients with bipolar I disorder.
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Affiliation(s)
- Berkay Vahapoğlu
- VAHAPOĞLU and ÖZDEMIR: Bakirköy Mazhar Osman Bakirköy Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey; POYRAZ: Department of Psychiatry, İstanbul University-Cerrahpaşa Medical School, Istanbul, Turkey
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5
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Blanken MAJT, Oudega ML, Almeida OP, Schouws SNTM, Orhan M, Beunders AJM, Klumpers UMH, Sonnenberg C, Blumberg HP, Eyler LT, Forester BP, Forlenza OV, Gildengers A, Mulsant BH, Rajji T, Rej S, Sarna K, Sutherland A, Yala J, Vieta E, Tsai S, Briggs FBS, Sajatovic M, Dols A. Sex Differences Among Older Adults With Bipolar Disorder: Results From the Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project. Am J Geriatr Psychiatry 2024; 32:326-338. [PMID: 37981507 DOI: 10.1016/j.jagp.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Sex-specific research in adult bipolar disorder (BD) is sparse and even more so among those with older age bipolar disorder (OABD). Knowledge about sex differences across the bipolar lifespan is urgently needed to target and improve treatment. To address this gap, the current study examined sex differences in the domains of clinical presentation, general functioning, and mood symptoms among individuals with OABD. METHODS This Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) study used data from 19 international studies including BD patients aged ≥50 years (N = 1,185: 645 women, 540 men).A comparison of mood symptoms between women and men was conducted initially using two-tailed t tests and then accounting for systematic differences between the contributing cohorts by performing generalized linear mixed models (GLMMs). Associations between sex and other clinical characteristics were examined using GLMM including: age, BD subtype, rapid cycling, psychiatric hospitalization, lifetime psychiatric comorbidity, and physical health comorbidity, with study cohort as a random intercept. RESULTS Regarding depressive mood symptoms, women had higher scores on anxiety and hypochondriasis items. Female sex was associated with more psychiatric hospitalizations and male sex with lifetime substance abuse disorders. CONCLUSION Our findings show important clinical sex differences and provide support that older age women experience a more severe course of BD, with higher rates of psychiatric hospitalization. The reasons for this may be biological, psychological, or social. These differences as well as underlying mechanisms should be a focus for healthcare professionals and need to be studied further.
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Affiliation(s)
- Machteld A J T Blanken
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands
| | - Mardien L Oudega
- Department of Psychiatry (MLO), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam Public Health, Mental Health Program, GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands.
| | - Osvaldo P Almeida
- Medical School (OPA), University of Western Australia, Perth, Australia
| | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry (SNTMS, AJMB), Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Melis Orhan
- Department of Clinical Psychology (MO), Leiden University, Leiden, The Netherlands
| | - Alexandra J M Beunders
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry (SNTMS, AJMB), Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Ursula M H Klumpers
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands
| | - Caroline Sonnenberg
- GGZ Parnassia NH, Specialized Mental Health Care (CS), Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry (HPB), Yale School of Medicine, New Haven, CT
| | - Lisa T Eyler
- Department of Psychiatry (LTE), University of California San Diego, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA
| | - Brent P Forester
- Division of Geriatric Psychiatry (BPF), McLean Hospital, Harvard Medical School, Boston, MA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry (OVF), HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariel Gildengers
- Department of Psychiatry (AG), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Benoit H Mulsant
- Department of Psychiatry (BHM) and Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Tarek Rajji
- Adult Neurodevelopment and Geriatric Psychiatry Division (TR), Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Soham Rej
- Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine (KS), Cleveland, OH
| | - Ashley Sutherland
- Department of Psychiatry (AS), University of California San Diego, San Diego, CA
| | - Joy Yala
- Case Western Reserve University School of Medicine (JY), Cleveland, OH
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit (EV), Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Shangying Tsai
- Department of Psychiatry (ST), School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Farren B S Briggs
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine (MS), University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Annemiek Dols
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands; Department of Psychiatry (AD), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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6
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Chen P, Sajatovic M, Briggs FBS, Mulsant B, Dols AA, Gildengers A, Yala J, Beunders AJM, Blumberg HP, Rej S, Forlenza OV, Jimenez E, Schouws S, Orhan M, Sutherland AN, Vieta E, Tsai S, Sarna K, Eyler LT. Sociodemographic and clinical characteristics of people with oldest older age bipolar disorder in a global sample: Results from the global aging and geriatric experiments in bipolar disorder project. Int J Geriatr Psychiatry 2024; 39:e6073. [PMID: 38393311 DOI: 10.1002/gps.6073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
OBJECTS Studies of older age bipolar disorder (OABD) have mostly focused on "younger old" individuals. Little is known about the oldest OABD (OOABD) individuals aged ≥70 years old. The Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) project provides an opportunity to evaluate the OOABD group to understand their characteristics compared to younger groups. METHODS We conducted cross-sectional analyses of the GAGE-BD database, an integrated, harmonized dataset from 19 international studies. We compared the sociodemographic and clinical characteristics of those aged <50 (YABD, n = 184), 50-69 (OABD, n = 881), and ≥70 (OOABD, n = 304). To standardize the comparisons between age categories and all characteristics, we used multinomial logistic regression models with age category as the dependent variable, with each characteristic as the independent variable, and clustering of standard errors to account for the correlation between observations from each of the studies. RESULTS OOABD and OABD had lower severity of manic symptoms (Mean YMRS = 3.3, 3.8 respectively) than YABD (YMRS = 7.6), and lower depressive symptoms (% of absent = 65.4%, and 59.5% respectively) than YABD (18.3%). OOABD and OABD had higher physical burden than YABD, especially in the cardiovascular domain (prevalence = 65% in OOABD, 41% in OABD and 17% in YABD); OOABD had the highest prevalence (56%) in the musculoskeletal domain (significantly differed from 39% in OABD and 31% in YABD which didn't differ from each other). Overall, OOABD had significant cumulative physical burden in numbers of domains (mean = 4) compared to both OABD (mean = 2) and YABD (mean = 1). OOABD had the lowest rates of suicidal thoughts (10%), which significantly differed from YABD (26%) though didn't differ from OABD (21%). Functional status was higher in both OOABD (GAF = 63) and OABD (GAF = 64), though only OABD had significantly higher function than YABD (GAF = 59). CONCLUSIONS OOABD have unique features, suggesting that (1) OOABD individuals may be easier to manage psychiatrically, but require more attention to comorbid physical conditions; (2) OOABD is a survivor cohort associated with resilience despite high medical burden, warranting both qualitative and quantitative methods to better understand how to advance clinical care and ways to age successfully with BD.
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Affiliation(s)
- Peijun Chen
- Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Farren B S Briggs
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Annemiek A Dols
- GGZ inGeest, Amsterdam, the Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joy Yala
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Alexandra J M Beunders
- GGZ inGeest, Amsterdam, the Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Soham Rej
- Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Orestes V Forlenza
- Department and Institute of Psychiatry, Laboratory of Neuroscience (LIM-27), HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Department of Psychiatry, Hospital Universitario de Alava, BIOARABA, UPV/EHU, CIBERSAM, Vitoria, Spain
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam, the Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands
| | - Melis Orhan
- Department of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | - Ashley N Sutherland
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Shangying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
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7
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Montejo L, Sole B, Fortea L, Jimenez E, Martinez-Aran A, Martinez-Heras E, Sanchez-Moreno J, Ortuño M, Pariente J, Solanes A, Torrent C, Vilajosana E, De Prisco M, Vieta E, Radua J. Study protocol - elucidating the neural correlates of functional remediation for older adults with bipolar disorder. Front Psychiatry 2024; 14:1302255. [PMID: 38298927 PMCID: PMC10827946 DOI: 10.3389/fpsyt.2023.1302255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Beyond mood abnormalities, bipolar disorder (BD) includes cognitive impairments that worsen psychosocial functioning and quality of life. These deficits are especially severe in older adults with BD (OABD), a condition expected to represent most individuals with BD in the upcoming years. Restoring the psychosocial functioning of this population will thus soon represent a public health priority. To help tackle the problem, the Bipolar and Depressive Disorders Unit at the Hospital Clínic of Barcelona has recently adapted its Functional Remediation (FR) program to that population, calling it FROA-BD. However, while scarce previous studies localize the neural mechanisms of cognitive remediation interventions in the dorsal prefrontal cortex, the specific mechanisms are seldom unknown. In the present project, we will investigate the neural correlates of FR-OABD to understand its mechanisms better and inform for potential optimization. The aim is to investigate the brain features and changes associated with FROA-BD efficacy. Methods Thirty-two individuals with OABD in full or partial remission will undergo a magnetic resonance imaging (MRI) session before receiving FR-OABD. After completing the FR-OABD intervention, they will undergo another MRI session. The MRI sessions will include structural, diffusion-weighted imaging (DWI), functional MRI (fMRI) with working memory (n-back) and verbal learning tasks, and frontal spectroscopy. We will correlate the pre-post change in dorsolateral and dorsomedial prefrontal cortices activation during the n-back task with the change in psychosocial functioning [measured with the Functioning Assessment Short Test (FAST)]. We will also conduct exploratory whole-brain correlation analyses between baseline or pre-post changes in MRI data and other clinical and cognitive outcomes to provide more insights into the mechanisms and explore potential brain markers that may predict a better treatment response. We will also conduct separate analyses by sex. Discussion The results of this study may provide insights into how FROA-BD and other cognitive remediations modulate brain function and thus could optimize these interventions.
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Affiliation(s)
- Laura Montejo
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Brisa Sole
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Lydia Fortea
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Anabel Martinez-Aran
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Psicologia Clínica i Psicobiologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Eloy Martinez-Heras
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic Barcelona, Fundació de Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
| | - Jose Sanchez-Moreno
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Ortuño
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Jose Pariente
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Aleix Solanes
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carla Torrent
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Enric Vilajosana
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Joaquim Radua
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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Mallu A, Chan CK, Eyler LT, Dols A, Rej S, Blumberg HP, Sarna K, Forester BP, Patrick RE, Forlenza OV, Jimenez E, Vieta E, Schouws S, Sutherland A, Yala J, Briggs FBS, Sajatovic M. Demographic and clinical associations to employment status in older-age bipolar disorder: Analysis from the GAGE-BD database project. Bipolar Disord 2023; 25:637-647. [PMID: 37798096 PMCID: PMC10843228 DOI: 10.1111/bdi.13381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE The current literature on employment in older adults with bipolar disorder (OABD) is limited. Using the Global Aging and Geriatric Experiments in Bipolar Disorder Database (GAGE-BD), we examined the relationship of occupational status in OABD to other demographic and clinical characteristics. METHODS Seven hundred and thirty-eight participants from 11 international samples with data on educational level and occupational status were included. Employment status was dichotomized as employed versus unemployed. Generalized linear mixed models with random intercepts for the study cohort were used to examine the relationship between baseline characteristics and employment. Predictors in the models included baseline demographics, education, psychiatric symptom severity, psychiatric comorbidity, somatic comorbidity, and prior psychiatric hospitalizations. RESULTS In the sample, 23.6% (n = 174) were employed, while 76.4% were unemployed (n = 564). In multivariable logistic regression models, less education, older age, a history of both anxiety and substance/alcohol use disorders, more prior psychiatric hospitalizations, and higher levels of BD depression severity were associated with greater odds of unemployment. In the subsample of individuals less than 65 years of age, findings were similar. No significant association between manic symptoms, gender, age of onset, or employment status was observed. CONCLUSION Results suggest an association between educational level, age, psychiatric severity and comorbidity in relation to employment in OABD. Implications include the need for management of psychiatric symptoms and comorbidity across the lifespan, as well as improving educational access for people with BD and skills training or other support for those with work-life breaks to re-enter employment and optimize the overall outcome.
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Affiliation(s)
- Amulya Mallu
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Carol K Chan
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location VU Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Soham Rej
- Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Brent P Forester
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Regan E Patrick
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, ISCIII, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, ISCIII, Barcelona, Catalonia, Spain
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam UMC, location VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ashley Sutherland
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Joy Yala
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
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9
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Lavin P, Rej S, Olagunju AT, Teixeira AL, Dols A, Alda M, Almeida OP, Altinbas K, Balanzá-Martínez V, Barbosa IG, Blumberg HP, Briggs F, Calkin C, Cassidy K, Forester BP, Forlenza OV, Hajek T, Haarman BCM, Jimenez E, Lafer B, Mulsant B, Oluwaniyi SO, Patrick R, Radua J, Schouws S, Sekhon H, Simhandl C, Soares JC, Tsai SY, Vieta E, Villa LM, Sajatovic M, Eyler LT. Essential data dimensions for prospective international data collection in older age bipolar disorder (OABD): Recommendations from the GAGE-BD group. Bipolar Disord 2023; 25:554-563. [PMID: 36843436 DOI: 10.1111/bdi.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND By 2030, over 50% of individuals living with bipolar disorder (BD) are expected to be aged ≥50 years. However, older age bipolar disorder (OABD) remains understudied. There are limited large-scale prospectively collected data organized in key dimensions capable of addressing several fundamental questions about BD affecting this subgroup of patients. METHODS We developed initial recommendations for the essential dimensions for OABD data collection, based on (1) a systematic review of measures used in OABD studies, (2) a Delphi consensus of international OABD experts, (3) experience with harmonizing OABD data in the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD, n ≥ 4500 participants), and (4) critical feedback from 34 global experts in geriatric mental health. RESULTS We identified 15 key dimensions and variables within each that are relevant for the investigation of OABD: (1) demographics, (2) core symptoms of depression and (3) mania, (4) cognition screening and subjective cognitive function, (5) elements for BD diagnosis, (6) descriptors of course of illness, (7) treatment, (8) suicidality, (9) current medication, (10) psychiatric comorbidity, (11) psychotic symptoms, (12) general medical comorbidities, (13) functioning, (14) family history, and (15) other. We also recommend particular instruments for capturing some of the dimensions and variables. CONCLUSION The essential data dimensions we present should be of use to guide future international data collection in OABD and clinical practice. In the longer term, we aim to establish a prospective consortium using this core set of dimensions and associated variables to answer research questions relevant to OABD.
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Affiliation(s)
- Paola Lavin
- Department of Geriatric Psychiatry, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Soham Rej
- Department of Geriatric Psychiatry, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Antonio L Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas/McGovern Medical School, Houston, Texas, USA
| | - Annemieke Dols
- Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Kursat Altinbas
- Selçuk University Medical Faculty, Department of Psychiatry, Mazhar Osman Mood Clinic, Konya, Turkey
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
| | - Izabela G Barbosa
- Laboratório Interdisciplinar de Investigação Médica da Faculdad de Medicina, Universidad Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farren Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Cynthia Calkin
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristin Cassidy
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdad de Medicina da Universidad de São Paulo, São Paulo, Brazil
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Barthomeus C M Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Beny Lafer
- Department of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Regan Patrick
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | - Joaquim Radua
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Solna, Sweden
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Harmehr Sekhon
- Department of Geriatric Psychiatry, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Simhandl
- Medical Faculty, Bipolar Center Wiener Neustadt, Sigmund Freud University, Wien, Austria
| | - Jair C Soares
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Houston, Texas, USA
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Luca M Villa
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Martha Sajatovic
- Departments of Psychiatry and of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
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10
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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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11
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Assessment and Management of Bipolar Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:399-400. [PMID: 38695006 PMCID: PMC11058948 DOI: 10.1176/appi.focus.23021017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
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Abstract
PURPOSE OF REVIEW Older age bipolar disorder (OABD) refers to patients with bipolar disorder aged 50 years and over. There is a paucity of evidence-based guidelines specific to OABD, but in recent years, several studies have been published on OABD. The current review synthesizes previous literature (up to January 1, 2021) as well as most recent literature on OABD (since January 1, 2021). RECENT FINDINGS This review covers the following themes: diagnosis and specifiers, clinical course, psychosocial functioning, cognition, physical comorbidities, and pharmacotherapy. On the basis of the latest data, specific clinical recommendations are proposed for each theme. SUMMARY OABD forms a more complex subgroup of bipolar disorder, with an increased risk of cognitive deficits, physical comorbidities, impaired psychosocial functioning, and premature death. The distinctions between BD-I and BD-II and between EOBD and LOBD do not clinically represent relevant subtypes for OABD patients. Mental healthcare professionals should treat all OABD patients with an integrative care model that takes into account cognitive and physical comorbidities and that contains elements aimed at improvement of psychosocial functioning and quality of life. Older age itself should not be a reason to withhold lithium treatment. Future research should collect data on essential data domains using validated measurement scales.
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Affiliation(s)
- Alexandra J M Beunders
- GGZ inGeest Specialized Mental Healthcare
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam
| | - Melis Orhan
- Institute of Clinical Psychology, Leiden University, Leiden
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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13
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Montejo L, Orhan M, Chen P, Eyler LT, Gildengers A, Martinez-Aran A, Nunes PV, Olagunju AT, Patrick R, Vieta E, Dols A, Jimenez E. Functioning in older adults with bipolar disorder: A report on recommendations by the International Society of bipolar disorder (ISBD) older adults with bipolar disorder (OABD) task force. Bipolar Disord 2023; 25:457-468. [PMID: 37495508 DOI: 10.1111/bdi.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Despite the importance of psychosocial functioning impairment in Bipolar Disorder (BD), its role among Older Adults with BD (OABD) is not well known. The development of guidelines for the assessment of psychosocial functioning helps to facilitate a better understanding of OABD and can lead to better tailored interventions to improve the clinical outcomes of this population. METHODS Through a series of virtual meetings, experts from eight countries in the International Society of Bipolar Disorder (ISBD) on OABD task force developed recommendations for the assessment of psychosocial functioning. RESULTS We present (1) a conceptualization of functioning in OABD and differences compared with younger patients; (2) factors related to functioning in OABD; (3) current measures of functioning in OABD and their strengths and limitations; and, (4) other potential sources of information to assess functioning. CONCLUSIONS The task force created recommendations for assessing functioning in OABD. Current instruments are limited, so measures specifically designed for OABD, such as the validated FAST-O scale, should be more widely adopted. Following the proposed recommendations for assessment can improve research and clinical care in OABD and potentially lead to better treatment outcomes.
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Affiliation(s)
- Laura Montejo
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Melis Orhan
- Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, the Netherlands
| | - Peijun Chen
- Department of Psychiatry, Geriatric Research, Education, and Clinical Center, VA Northeast Ohio Health System Cleveland VA Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare, San Diego, California, USA
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anabel Martinez-Aran
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Paula Villela Nunes
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Regan Patrick
- Departments of Neuropsychology & Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
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14
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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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15
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Janiri D, Sampogna G, Albert U, Caraci F, Martinotti G, Serafini G, Tortorella A, Zuddas A, Fiorillo A, Sani G. Lithium use in childhood and adolescence, peripartum, and old age: an umbrella review. Int J Bipolar Disord 2023; 11:8. [PMID: 36781741 PMCID: PMC9925650 DOI: 10.1186/s40345-023-00287-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Lithium is one of the most consistently effective treatment for mood disorders. However, patients may show a high level of heterogeneity in treatment response across the lifespan. In particular, the benefits of lithium use may vary in special clinical conditions. The aim of this study was to test this hypothesis by conducting an umbrella review on the efficacy and safety of lithium in childhood and adolescence, peripartum and old age. METHODS We applied the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria (PRISMA) to identify systematic reviews/meta-analyses on the efficacy and/or safety of lithium in mood disorders in special clinical conditions: (i) childhood and adolescence; (ii) peripartum (pregnancy, postpartum and lactation); (iii) old age. The Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) tool was used to assess the risk of bias. Overlap in primary studies across systematic reviews was calculated through the Corrected Covered Area (CCA). RESULTS We included 20 independent studies, for a total of 8209 individuals treated with lithium. Regarding paediatric age, efficacy and safety results suggested that lithium may be superior to placebo in bipolar disorders (BD) and not associated with serious adverse events. Nevertheless, primary available data are very limited. Efficacy in paediatric major depressive disorder (MDD) is not clear. During peripartum, lithium use was superior to non-lithium in preventing mood episodes and it was associated with low risk of congenital anomalies and with normal child neurodevelopment. Regarding old age, limited evidence supported lithium as an effective treatment in BD and resistant MDD; low doses should be used in this population. Systematic reviews on paediatric age showed the lowest risk of bias (80% of the studies at low risk). The CCA range of included studies was 13-47%. CONCLUSIONS This umbrella review supports the use of lithium across the lifespan, including special clinical condition. Nevertheless, more studies with increased methodological homogeneity are needed.
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Affiliation(s)
- Delfina Janiri
- grid.8142.f0000 0001 0941 3192Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy ,grid.411075.60000 0004 1760 4193Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gaia Sampogna
- grid.9841.40000 0001 2200 8888Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Umberto Albert
- grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy ,Department of Mental Health, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI, Trieste, Italy
| | - Filippo Caraci
- grid.8158.40000 0004 1757 1969Department of Drug and Health Sciences, University of Catania, 95125 Catania, Italy ,grid.419843.30000 0001 1250 7659Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Giovanni Martinotti
- grid.412451.70000 0001 2181 4941Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, 66100 Chieti, Italy
| | - Gianluca Serafini
- grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy ,grid.410345.70000 0004 1756 7871IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alfonso Tortorella
- grid.9027.c0000 0004 1757 3630Department of Psychiatry, University of Perugia, Perugia, Italy
| | - Alessandro Zuddas
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy ,Child & Adolescent Neuropsychiatry Unit, “A. Cao” Paediatric Hospital, Cagliari, Italy
| | - Andrea Fiorillo
- grid.9841.40000 0001 2200 8888Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy. .,Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
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16
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Beunders AJM, Klaus F, Kok AAL, Schouws SNTM, Kupka RW, Blumberg HP, Briggs F, Eyler LT, Forester BP, Forlenza OV, Gildengers A, Jimenez E, Mulsant BH, Patrick RE, Rej S, Sajatovic M, Sarna K, Sutherland A, Yala J, Vieta E, Villa LM, Korten NCM, Dols A. Bipolar I and bipolar II subtypes in older age: Results from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) project. Bipolar Disord 2023; 25:43-55. [PMID: 36377516 DOI: 10.1111/bdi.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The distinction between bipolar I disorder (BD-I) and bipolar II disorder (BD-II) has been a topic of long-lasting debate. This study examined differences between BD-I and BD-II in a large, global sample of OABD, focusing on general functioning, cognition and somatic burden as these domains are often affected in OABD. METHODS Cross-sectional analyses were conducted with data from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) database. The sample included 963 participants aged ≥50 years (714 BD-I, 249 BD-II). Sociodemographic and clinical factors were compared between BD subtypes including adjustment for study cohort. Multivariable analyses were conducted with generalized linear mixed models (GLMMs) and estimated associations between BD subtype and (1) general functioning (GAF), (2) cognitive performance (g-score) and (3) somatic burden, with study cohort as random intercept. RESULTS After adjustment for study cohort, BD-II patients more often had a late onset ≥50 years (p = 0.008) and more current severe depression (p = 0.041). BD-I patients were more likely to have a history of psychiatric hospitalization (p < 0.001) and current use of anti-psychotics (p = 0.003). Multivariable analyses showed that BD subtype was not related to GAF, cognitive g-score or somatic burden. CONCLUSION BD-I and BD-II patients did not differ in terms of general functioning, cognitive impairment or somatic burden. Some clinical differences were observed between the groups, which could be the consequence of diagnostic definitions. The distinction between BD-I and BD-II is not the best way to subtype OABD patients. Future research should investigate other disease specifiers in this population.
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Affiliation(s)
- Alexandra J M Beunders
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands
| | - Federica Klaus
- Department of Psychiatry, University of California San Diego, San Diego, California, USA.,Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, USA
| | - Almar A L Kok
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands
| | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands
| | - Ralph W Kupka
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farren Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California, USA.,Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Benoit H Mulsant
- Department of Psychiatry, Center for Addiction & Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Regan E Patrick
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Soham Rej
- GeriPARTy Research Group, Jewish General Hospital/ Lady Davis Institute, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Ashley Sutherland
- Department of Psychiatry, University of California San Diego, San Diego, California, USA.,Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, USA
| | - Joy Yala
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Luca M Villa
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Nicole C M Korten
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands
| | - Annemieke Dols
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.,Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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17
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Davies TL. Tailoring the mental health assessment to older adults. Nurse Pract 2023; 48:10-18. [PMID: 36573854 DOI: 10.1097/01.npr.0000902992.34389.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
ABSTRACT This article discusses selected considerations for mental health assessment in older adults. Adopting a biopsychosocial model and trauma-informed approach to care creates a safe structure for a more comprehensive assessment. Selecting appropriate tools to improve diagnostic reasoning sets the foundation for further workup and tailored interventions.
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Affiliation(s)
- Tracy Lynn Davies
- Tracy Lynn Davies is Assistant Professor and Program Director of the Psychiatric Mental Health Nurse Practitioner Post-Graduate Certificate Program at Washburn University in Topeka, Kan
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18
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Martinez D, Lavebratt C, Millischer V, de Jesus R. de Paula V, Pires T, Michelon L, Camilo C, Esteban N, Pereira A, Schalling M, Vallada H. Shorter telomere length and suicidal ideation in familial bipolar disorder. PLoS One 2022; 17:e0275999. [PMID: 36469522 PMCID: PMC9721487 DOI: 10.1371/journal.pone.0275999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/27/2022] [Indexed: 12/12/2022] Open
Abstract
Bipolar Disorder (BD) has recently been related to a process of accelerated aging, with shortened leukocyte telomere length (LTL) in this population. It has also been observed that the suicide rate in BD patients is higher than in the general population, and more recently the telomere length variation has been described as shorter in suicide completers compared with control subjects. Objectives The aim of the present study was to investigate if there is an association between LTL and BD in families where two or more members have BD including clinical symptomatology variables, along with suicide behavior. Methods Telomere length and single copy gene ratio (T/S ratio) was measured using quantitative polymerase chain reaction in a sample of 143 relatives from 22 families, of which 60 had BD. The statistical analysis was performed with a polygenic mixed model. Results LTL was associated with suicidal ideation (p = 0.02) as that there is an interaction between suicidal ideation and course of the disorder (p = 0.02). The estimated heritability for LTL in these families was 0.68. In addition, covariates that relate to severity of disease, i.e. suicidal ideation and course of the disorder, showed an association with shorter LTL in BD patients. No difference in LTL between BD patients and healthy relatives was observed. Conclusion LTL are shorter in subjects with familial BD suggesting that stress related sub-phenotypes possibly accelerate the process of cellular aging and correlate with disease severity and suicidal ideation.
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Affiliation(s)
- Daniela Martinez
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Laboratório de Genética e Cardiologia Molecular, Instituto do Coração, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Catharina Lavebratt
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Vincent Millischer
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Vanessa de Jesus R. de Paula
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Thiago Pires
- Laboratório de Genética e Cardiologia Molecular, Instituto do Coração, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Leandro Michelon
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caroline Camilo
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nubia Esteban
- Laboratório de Genética e Cardiologia Molecular, Instituto do Coração, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alexandre Pereira
- Laboratório de Genética e Cardiologia Molecular, Instituto do Coração, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Martin Schalling
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Homero Vallada
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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19
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Forlenza OV, Hajek T, Almeida OP, Beunders AJ, Blumberg HP, Briggs FB, De-Paula VJR, Dols A, Eyler LT, Forester BP, Gildengers A, Jimenez E, Korten NC, Lafer B, McWhinney SR, Mulsant B, Rej S, Sarna K, Schouws S, Sutherland A, Tsai S, Vieta E, Yala J, Sajatovic M. Demographic and clinical characteristics of lithium-treated older adults with bipolar disorder. Acta Psychiatr Scand 2022; 146:442-455. [PMID: 35837985 PMCID: PMC9588573 DOI: 10.1111/acps.13474] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES There is limited information on the characteristics of older adults with bipolar disorder (OABD) treated with lithium, along with safety concerns about its use by older adults. The aim of the present study is to describe the demographic and clinical characteristics of OABD receiving lithium therapy, using data from the Global Ageing & Geriatric Experiments in Bipolar Disorder (GAGE-BD). EXPERIMENTAL PROCEDURES Cross-sectional analysis of the GAGE-BD dataset to determine differences and similarities between lithium users and non-users. We analysed data from 986 participants aged 50 years or older (mean age 63.5 years; 57.5% females) from 12 study sites. Two subgroups ('Lithium'; 'Non-lithium') were defined according to the current prescription of lithium. We compared several outcomes between these groups, controlling for age, gender, and study site. RESULTS OABD treated with lithium had lower scores on depression rating scales and were less likely to be categorised as with moderate or severe depression. There was a lower proportion of lithium users than non-users among those with evidence of rapid cycling and non-bipolar psychiatric diagnoses. Assessment of global cognitive state and functionality indicated better performance among lithium users. The current use of antipsychotics was less frequent among lithium users, who also reported fewer cardiovascular comorbidities than non-users. CONCLUSION We found several potentially relevant differences in the clinical profile of OABD treated with lithium compared with those treated with other mood stabilisers. However, the interpretation of the present results must take into account the methodological limitations inherent to the cross-sectional approach and data harmonisation.
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Affiliation(s)
- Orestes V. Forlenza
- Department & Institute of Psychiatry, Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | | | - Alexandra J.M. Beunders
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | | | - Farren B.S. Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Vanessa J. R. De-Paula
- Vanessa J. R. De-Paula, Laboratory of Neuroscience (LIM-27), Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | - Annemiek Dols
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | - Lisa T. Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, USA
| | - Brent P. Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont; Harvard Medical School, Boston, USA
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Nicole C.M. Korten
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | - Beny Lafer
- Department & Institute of Psychiatry, Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | | | - Benoit Mulsant
- Benoit Mulsant, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada
| | - Soham Rej
- Soham Rej, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada
| | - Kaylee Sarna
- Kaylee Sarna, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | - Ashley Sutherland
- Ashley Sutherland, Department of Psychiatry, University of California at San Diego, San Diego, USA
| | - Shangying Tsai
- Shangying Tsai, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Joy Yala
- Kaylee Sarna, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Martha Sajatovic
- Kaylee Sarna, Case Western Reserve University School of Medicine, Cleveland, USA
- Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD): please see Supplemental Material for members of the GAGE-BD initiative
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20
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Lavin P, Buck G, Almeida OP, Su CL, Eyler LT, Dols A, Blumberg HP, Forester BP, Forlenza OV, Gildengers A, Mulsant BH, Tsai SY, Vieta E, Schouws S, Briggs FBS, Sutherland A, Sarna K, Yala J, Orhan M, Korten N, Sajatovic M, Rej S. Clinical correlates of late-onset versus early-onset bipolar disorder in a global sample of older adults. Int J Geriatr Psychiatry 2022; 37. [PMID: 36317317 DOI: 10.1002/gps.5833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/16/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Late-onset bipolar disorder (LOBD) represents a significant subgroup of bipolar disorder (BD). However, knowledge for this group is mostly extrapolated from small studies in subjects with early/mixed age of illness onset. In this global sample of older adults with BD (OABD: ≥50 years old) we aim to characterize the sociodemographic and clinical presentation of LOBD (≥40 years at BD onset) compared to early-onset BD (EOBD: <40 years at BD onset). METHODS The Global Aging and Geriatric Experiments in Bipolar Disorder consortium provided international data on 437 older age bipolar disorder participants. We compared LOBD versus EOBD on depression, mania, functionality, and physical comorbidities. Exploratory analyses were performed on participants with BD onset ≥50 years old. RESULTS LOBD (n = 105) did not differ from EOBD (n = 332) on depression, mania, global functioning, nor employment status (p > 0.05). Late-onset bipolar disorder was associated with higher endocrine comorbidities (odds ratio = 1.48, [95%CI = 1.0,12.1], p = 0.03). This difference did not remain significant when subjects with BD onset ≥50 years old were analyzed. LIMITATIONS This study is limited by the retrospective nature of the variable age of onset and the differences in evaluation methods across studies (partially overcame by harmonization processes). CONCLUSION The present analysis is in favor of the hypothesis that LOBD might represent a similar clinical phenotype as classic EOBD with respect to core BD symptomatology, functionality, and comorbid physical conditions. Large-scale global collaboration to improve our understanding of BD across the lifespan is needed.
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Affiliation(s)
- Paola Lavin
- GeriPARTy Research Group, Jewish General Hospital, Montreal, Quebec, Canada
- Lady Davis Research Institute, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Gabriella Buck
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Chien-Lin Su
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, San Diego Healthcare System, San Diego, California, USA
| | - Annemieke Dols
- GGZ InGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Brent P Forester
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience, Instituto de Psiquiatría, Hospital da Universidad de São Paulo, Sao Paulo, Brazil
| | - Ariel Gildengers
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Benoit H Mulsant
- Department of Psychiatry, Center for Addiction & Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eduard Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Sigfried Schouws
- GGZ InGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Ashley Sutherland
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Joy Yala
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Melis Orhan
- GGZ InGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Nicole Korten
- GGZ InGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Soham Rej
- GeriPARTy Research Group, Jewish General Hospital, Montreal, Quebec, Canada
- Lady Davis Research Institute, McGill University, Montreal, Quebec, Canada
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21
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Eyler LT, Briggs FBS, Dols A, Rej S, Almeida OP, Beunders AJM, Blumberg HP, Forester BP, Patrick RE, Forlenza OV, Gildengers A, Jimenez E, Vieta E, Mulsant BH, Schouws S, Paans NPG, Strejilevich S, Sutherland A, Tsai S, Sajatovic M. Symptom Severity Mixity in Older-Age Bipolar Disorder: Analyses From the Global Aging and Geriatric Experiments in Bipolar Disorder Database (GAGE-BD). Am J Geriatr Psychiatry 2022; 30:1096-1107. [PMID: 35637088 PMCID: PMC10280310 DOI: 10.1016/j.jagp.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Some individuals with bipolar disorder (BD) experience manic and depressive symptoms concurrently, but data are limited on symptom mixity in older age bipolar disorder (OABD). Using the Global Aging & Geriatric Experiments in Bipolar Disorder Database, we characterized mixity in OABD and associations with everyday function. METHODS The sample (n = 805), from 12 international studies, included cases with both mania and depression severity ratings at a single timepoint. Four mixity groups were created: asymptomatic (A), mixed (Mix), depressed only (Dep), and manic only (Man). Generalized linear mixed models used mixity group as the predictor variable; cohort was included as a random intercept. Everyday function was assessed with the Global Assessment of Functioning score. RESULTS Group proportions were Mix (69.6%; n = 560), followed by Dep (18.4%; n = 148), then A (7.8%; n = 63), then Man (4.2%; n= 34); levels of depression and mania were similar in Mix compared to Dep and Man, respectively. Everyday function was lowest in Mix, highest in A, and intermediate in Man and Dep. Within Mix, severity of depression was the main driver of worse functioning. Groups differed in years of education, with A higher than all others, but did not differ by age, gender, employment status, BD subtype, or age of onset. CONCLUSIONS Mixed features predominate in a cross-sectional, global OABD sample and are associated with worse everyday function. Among those with mixed symptoms, functional status relates strongly to current depression severity. Future studies should include cognitive and other biological variables as well as longitudinal designs to allow for evaluation of causal effects.
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Affiliation(s)
- Lisa T Eyler
- Department of Psychiatry (LTE), University of California San Diego, San Diego, CA; Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (LTE), San Diego, CA.
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences (FBSB), Case Western Reserve University School of Medicine, Cleveland, OH
| | - Annemiek Dols
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute (AD, AJMB, SS, NPGP), Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program and Neurodegeneration program, Amsterdam, the Netherlands
| | - Soham Rej
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program and Neurodegeneration program, Amsterdam, the Netherlands
| | | | - Alexandra J M Beunders
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute (AD, AJMB, SS, NPGP), Amsterdam, the Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry (HPB), Yale School of Medicine, New Haven, CT
| | - Brent P Forester
- Division of Geriatric Psychiatry (BPF), McLean Hospital, Belmont, MA; Harvard Medical School (BPF, REP), Boston, MA
| | - Regan E Patrick
- Harvard Medical School (BPF, REP), Boston, MA; Division of Geriatric Psychiatry (REP), McLean Hospital, Belmont, MA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry (OVF), HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariel Gildengers
- Department of Psychiatry (AG), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic (EJ, EV), University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic (EJ, EV), University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Benoit H Mulsant
- Department of Psychiatry (BHM), University of Toronto, Center for Addiction & Mental Health, Toronto, Canada
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute (AD, AJMB, SS, NPGP), Amsterdam, the Netherlands; GGZ inGeest, Amsterdam UMC (SS), VU Medical Center, Amsterdam, the Netherlands
| | - Nadine P G Paans
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute (AD, AJMB, SS, NPGP), Amsterdam, the Netherlands; GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute (NPGP), Amsterdam, the Netherlands
| | - Sergio Strejilevich
- AREA, Assistance and Research in Affective Disorders (SS), Buenos Aires, Argentina
| | - Ashley Sutherland
- Department of Psychiatry (AS), University of California San Diego, San Diego, CA
| | - Shangying Tsai
- Department of Psychiatry, School of Medicine (ST), College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine (MS), University Hospitals Cleveland Medical Center, Cleveland, OH
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22
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Orhan M, Millett C, Klaus F, Blumberg HP, Briggs F, Chung KH, Korten N, McManus K, van Oppen P, Patrick RE, Sarna K, Sutherland A, Tsai SY, Villa LM, Yala J, Sajatovic M, Burdick KE, Eyler L, Dols A. Comparing continuous and harmonized measures of depression severity in older adults with bipolar disorder: Relationship to functioning. J Affect Disord 2022; 314:44-49. [PMID: 35803392 DOI: 10.1016/j.jad.2022.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/30/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Harmonizing different depression severity scales often requires creation of categorical variables that may decrease the sensitivity of the measure. Our aim was to compare the associations between categorical and continuous and harmonized measures of depression and global functioning in a large dataset of older age patients with bipolar disorder (OABD). METHOD In the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) the 17-item Hamilton Depression scale (HAM-D), Montgomery Asberg Depression Rating Scale (MADRS) or the Center for Epidemiological Studies Depression scales (CES-D) was used to assess current depressive symptoms, while the Global Assessment of Functioning (GAF) assessed functional status. Data were harmonized from 8 OABD studies (n = 582). In each subsample, the relationship of depression severity as a continuous and categorical measure was compared to GAF. In the total sample, harmonized ordinal depression categories were compared to GAF. RESULTS Effect size and variance explained by the model for the categorical measure in the total sample was higher than both the categorical and continuous measure in the CES-D subsample, higher than the categorical but lower than the continuous measure in the HAM-D subsample, and lower than both the categorical and continuous measures in the MADRS subsample. LIMITATIONS All included studies have different inclusion and exclusion criteria, study designs, and differ in aspects of sociodemographic variables. CONCLUSIONS Associations were only slightly larger for the continuous vs categorical measures of depression scales. Harmonizing different depression scales into ordinal categories for analyses is feasible without losing statistical power.
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Affiliation(s)
- Melis Orhan
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Caitlin Millett
- Mood and Psychosis Research Program, Brigham and Women's Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Federica Klaus
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
| | - Hilary P Blumberg
- Psychiatry, Radiology and Biomedical Imaging, Child Study Center, Mood Disorders Research Program, Yale School of Medicine, New Haven, CT, USA
| | - Farren Briggs
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kuo-Hsuan Chung
- Department of Psychiatry and Psychiatric Research Center, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Nicole Korten
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Kaitlin McManus
- Neuropsychology & Geriatric Psychiatry, McLean Hospital, Harvard Medical School, USA
| | - Patricia van Oppen
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Regan E Patrick
- Neuropsychology & Geriatric Psychiatry, McLean Hospital, Harvard Medical School, USA
| | - Kaylee Sarna
- Mood and Psychosis Research Program, Brigham and Women's Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ashley Sutherland
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
| | - Shang-Ying Tsai
- Department of Psychiatry and Psychiatric Research Center, Taipei Medical University, Taipei, Taiwan
| | - Luca M Villa
- Department of Psychiatry, University of Oxford, UK; Yale School of Medicine, New Haven, CT, USA
| | - Joy Yala
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Katherine E Burdick
- Mood and Psychosis Research Program, Brigham and Women's Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lisa Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
| | - Annemiek Dols
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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23
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Abstract
PURPOSE OF REVIEW The present review aims to examine, summarize and update information on the sociodemographic and cultural determinants of mood disorders. RECENT FINDINGS Known sociodemographic and cultural determinants continue to be good predictors of the risk of developing a mood disorder over the lifetime. Polygenic risk scores do not appear to offer any advantages over these determinants at present. There is also new and emerging understanding of the role of lifestyle and environmental factors in mediating vulnerability to mood disorder. The influence of ethnicity and migration, on the other hand, is far more complex than initially envisaged. SUMMARY Recent evidence on sociodemographic determinants of mood disorders confirms associations derived from existing literature. There is also new and emerging evidence on how quality of sleep, diet and the environment influence risk of mood disorders. Culture and ethnicity, depending on context, may contribute to both vulnerability and resilience. Socioeconomic deprivation may be the final common pathway through which several sociodemographic and cultural determinants of mood disorders act.
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Affiliation(s)
- Migita M D'cruz
- DM Geriatric Psychiatry, Consultant, Geriatric Psychiatry, Kollam, Kerala, India
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