Age of first onset of bipolar disorder: Demographic, family history, and psychosocial correlates

Department of Psychiatry, Duke University, Durham, North Carolina 27710, USA.
Depression and Anxiety (Impact Factor: 4.41). 01/1998; 7(2):76-82. DOI: 10.1002/(SICI)1520-6394(1998)7:2<76::AID-DA5>3.3.CO;2-C
Source: PubMed


The literature suggests that bipolar elders with early and late onset of the disorder present with different demographic, family history, and psychosocial profiles, which are less well characterized than those for elderly unipolar patients. In this cross-sectional clinical survey, we assessed subjects (n = 74) from the NIMH Clinical Research Center for the Study of Depression in Later Life at Duke University who had a consensus diagnosis of bipolar depression; the primary assessment instrument was the Duke Depression Evaluation Schedule. We found that bipolar subjects with later age of onset reported less family history of psychiatric problems, more comorbid vascular disease, and more instrumental and subjective social support. Stressful life events were more frequent among bipolar subjects with earlier age of depressive symptom onset. This study suggests that early-onset disorder may be characterized by a psychosocial component, whereas organic factors may be particularly important to late-onset bipolar disorder.

3 Reads
  • Source
    • "From early to late in the modern era of psychiatric research, life events have continued to be associated with, or predictive of, relapse in all three major psychotic disorders, major depression (Brown, 1998; Kendler, 1998; Malkoff Schwartz et al., 1998; Takeuchi et al., 1998; van Os et al., 1994), schizophrenia (Bebbington et al., 1993; Chafetz, Havassy, & Arean, 1997; Das, Kulhara, & Verma, 1997; Hirsch et al., 1996; Hultman, et al., 1997; Leff, 1994; Nuechterlein et al., 1994; van Os, et al., 1994) and bipolar disorder (Hays, Krishnan, George, & Blazer, 1998; Malkoff Schwartz, et al., 1998; van Os, et al., 1994). When measured, there is a tendency for life events to be more impactful when the patient is less vulnerable on a neurocognitive, genetic or severity of illness basis (Bebbington, et al., 1993; Malkoff Schwartz, et al., 1998; Pallanti, Quercioli, & Pazzagli, 1997; van Os, et al., 1994), when the illness is at an earlier stage (Hays, et al., 1998; Steinberg & Durell, 1968) and when medication is not being used (Hirsch, et al., 1996; Nuechterlein, et al., 1994). For young adults and adolescents the most potent events tend to be those that involve loss of supportive social ties, especially separation from, or death of, family members, romantic/marital losses for women and occupational disruptions for men. "

  • Source
    • "Illness severity is another strong predictor of psychosocial disability in BD [57]. Younger age of onset [58], longer duration of mood episodes [6], higher number of psychiatric hospitalizations [51], lingering residual symptoms [59] [60], psychosis [61], and substance use disorders [62] [63] all predict greater psychosocial dysfunction in BD. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous research on functional outcome in bipolar disorder (BD) has uncovered various factors that exacerbate psychosocial disability over the course of illness, including genetics, illness severity, stress, anxiety, and cognitive impairment. This paper presents an integrated view of these findings that accounts for the precipitous decline in psychosocial functioning after illness onset. The proposed model highlights a number of reciprocal pathways among previously studied factors that trap people in a powerful cycle of ailing forces. The paper discusses implications to patient care as well as the larger social changes required for shifting the functional trajectory of people with BD from psychosocial decline to growth.
    Depression research and treatment 01/2012; 2012(2090-1321):949248. DOI:10.1155/2012/949248
  • Source
    • "FFT may be effective in families with high emotional expression and IPSPT for patients for whom relationship problems cause depressive symptoms or precipitate mood episodes. It is known that psychosocial stressors may trigger mood episodes (Hays et al., 1998). The presence of these factors in relapse episodes may help with the selection of therapy models. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim of this systematic review was critical presentation of psychosocial approaches in bipolar disorders with regard to their fundamentals and impact on the clinical course and outcome of the illness. PubMed, Medline, PsycINFO and Turkish databases between 1980 and 2009 were searched by using keywords "bipolar disorder" and "psychotherapy", "psychosocial approaches", "psychological intervention". Randomized controlled trials, reviews and meta analysis were included. Fifty studies met the inclusion criteria where four types of interventions -psychoeducation, family focused, cognitive behavioral and interpersonal psychosocial rhythm therapy-were studied. Twenty two of 24 original research papers were randomized controlled trials, 23 were reviews and 3 were meta analysis. In almost all studies psychotherapeutic approach was applied as adjunctive to pharmacotherapy. Group psychoeducation was more effective in preventing manic relapses, whereas cognitive behavioral and family focused therapies showed efficacy in preventing depressive episodes. Additional benefits on such secondary outcomes as medication compliance, number and duration of hospitalizations, time to recurrence were reported. Effects on functionality and quality of life were assessed rarely, but reported to be beneficial. Cultural adaptation studies are scarce and needs exploration. Psychosocial interventions adjunctive to pharmacotherapy in bipolar disorder seem to be effective in relapse prevention. Stage of illness where the therapy is initiated and the targeted episode for prevention varies between interventions. Future studies are needed to strengthen the place of psychosocial interventions in treatment guidelines and would contribute to narrow the gap between effectiveness of pharmacotherapy and functional improvement.
    Turk psikiyatri dergisi = Turkish journal of psychiatry 06/2010; 21(2):143-54. DOI:10.5080/u6157 · 0.43 Impact Factor
Show more

Similar Publications