Age of first onset of bipolar disorder: Demographic, family history, and psychosocial correlates
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.
[Show abstract] [Hide abstract] ABSTRACT: Objective: One third of patients with a major depressive episode also experience manic symptoms or, even, a (hypo)manic episode. Retrospective studies on the temporal sequencing of symptomatology suggest that the majority of these patients report depressive symptoms before the onset of manic symptoms. However, prospective studies are scarce and this study will, therefore, prospectively examine the onset of either manic symptoms or a (hypo)manic episode in patients with a major depressive disorder. In addition, we will consider the impact of a large set of potential risk factors on both outcomes. Methodology: Four-year follow-up data were used to determine the onset of manic symptoms as well as a CIDI-based (hypo)manic episode in a large sample (n = 889, age: 18-65 years) of outpatients with a major depressive disorder and without manic symptoms at baseline. Baseline vulnerability (i.e., sociodemographics, family history of depression, childhood trauma, life-events) and clinical (i.e., isolated manic symptoms, depression characteristics, and psychiatric comorbidity) factors were considered as potential risk factors. Results: In our sample of depressed patients, 15.9% developed manic symptoms and an additional 4.7% developed a (hypo)manic episode during four years. Baseline isolated manic symptoms and comorbid alcohol dependence predicted both the onset of manic symptoms and a (hypo)manic episode. Low education only predicted the onset of manic symptoms, whereas male gender, childhood trauma and severity of depressive symptoms showed strong associations with, especially, the onset of (hypo)manic episodes. Conclusions: A substantial proportion (20.6%) of patients with a major depressive disorder later developed manic symptoms or a (hypo)manic episode. Interestingly, some identified risk factors differed for the two outcomes, which may indicate that pathways leading to the onset of manic symptoms or a (hypo)manic episode might be different. Our findings indirectly support a clinical staging model.0Comments 4Citations
- "Although these factors may be less important for late-onset manic symptoms or (hypo)manic episodes (i.e. focus of our study)3132, we would like to encourage future researchers to gather this information, also in older samples of depressed patients. Another important limitation is that the CIDI section on bipolar disorders was not conducted at baseline and, consequently, information about DSM-IV (hypo)manic episodes was not available at that time. "
- "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. "
[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.0Comments 17Citations
- "Illness severity is another strong predictor of psychosocial disability in BD . Younger age of onset , longer duration of mood episodes , higher number of psychiatric hospitalizations , lingering residual symptoms [59, 60], psychosis , and substance use disorders [62, 63] all predict greater psychosocial dysfunction in BD. The argument for a direct impact of illness severity on psychosocial functioning in BD probably provides the most intuitively appealing explanation for the correlation between these two variables. "