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Bipolare affektive Störungen im höheren Lebensalter

Bipolar affective disorders in senescence

Zeitschrift für Gerontologie und Geriatrie volume 51, pages 751–757 (2018)Cite this article

Zusammenfassung

Diagnostische und therapeutische Maßnahmen bei Patienten mit bipolaren Störungen unterscheiden sich je nach Alter der Betroffenen deutlich. Da sich heute ungefähr ein Viertel der Patienten mit bipolaren Störungen im Senium befindet, ist es für den Altersmediziner wichtig, diese Krankheitsbilder zu kennen. In der vorliegenden Übersichtsarbeit wird zunächst die Diagnostik der bipolaren Störungen beim alten Patienten vorgestellt. Wechselwirkungen mit somatischen Komorbiditäten, die u. a. zum Auftreten sekundärer Manien führen können – um nur eine der Besonderheiten im Alter herauszustellen –, werden behandelt. Altersspezifische Unterschiede bedeuten darüber hinaus das Erfordernis veränderter bzw. angepasster (pharmakologischer/nicht-pharmakologischer) Therapieschemata, die von denen jüngerer Patienten abweichen.

Abstract

Diagnostic and therapeutic measures in patients with bipolar disorders are significantly different depending on the age of those affected. Given the demographic changes and the fact that approximately one quarter of patients with bipolar disease are in old age, it is important for geriatricians to be aware of the specific aspects of bipolar disease. This review article presents the diagnostics of bipolar disorders in old people. Interactions with somatic comorbidities, which may lead to the occurrence of secondary mania, just to mention one of the characteristics of old age, are elaborated. Furthermore, age-specific differences also necessitate altered or adjusted therapy regimens, which deviate from those of younger patients.

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Literatur

  1. Wylie ME, Mulsant BH, Pollock BG, Sweet RA, Zubenko GS, Begley AE, Gregor M, Frank E, Reynolds CF 3rd, Kupfer DJ (1999) Age at onset in geriatric bipolar disorder. Effects on clinical presentation and treatment outcomes in an inpatient sample. Am J Geriatr Psychiatry 7(1):77–83

    CAS  PubMed  Google Scholar 

  2. Sajatovic M, Strejilevich SA, Gildengers AG, Dols A, Al Jurdi RK, Forester BP, Kessing LV, Beyer J, Manes F, Rej S, Rosa AR, Schouws SN, Tsai SY, Young RC, Shulman KI (2015) A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force. Bipolar Disord 17(7):689–704. https://doi.org/10.1111/bdi.12331

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dols A, Kessing LV, Strejilevich SA, Rej S, Tsai SY, Gildengers AG, Almeida OP, Shulman KI, Sajatovic M, International Society for Bipolar Disorders Task Force for Older Adults with Bipolar D (2016) Do current national and international guidelines have specific recommendations for older adults with bipolar disorder? A brief report. Int J Geriatr Psychiatry 31(12):1295–1300. https://doi.org/10.1002/gps.4534

    Article  PubMed  Google Scholar 

  4. Angst J, Gamma A, Benazzi F, Ajdacic V, Eich D, Rossler W (2003) Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord 73(1–2):133–146

    Article  Google Scholar 

  5. Ghaemi SN, Sachs GS, Chiou AM, Pandurangi AK, Goodwin K (1999) Is bipolar disorder still underdiagnosed? Are antidepressants overutilized? J Affect Disord 52(1–3):135–144

    CAS  Article  Google Scholar 

  6. Angst J, Sellaro R, Stassen HH, Gamma A (2005) Diagnostic conversion from depression to bipolar disorders: results of a long-term prospective study of hospital admissions. J Affect Disord 84(2–3):149–157. https://doi.org/10.1016/S0165-0327(03)00195-2

    Article  PubMed  Google Scholar 

  7. Benazzi F (2000) Late-life chronic depression: a 399-case study in private practice. Int J Geriatr Psychiatry 15(1):1–6

    CAS  Article  Google Scholar 

  8. Brieger P, Hensel J, Marneros A (2005) Bipolar affective and schizoaffective disorders of older age – classification, symptoms and course. Fortschr Neurol Psychiatr 73(6):343–351. https://doi.org/10.1055/s-2004-830246

    CAS  Article  PubMed  Google Scholar 

  9. Akiskal HS, Pinto O (1999) The evolving bipolar spectrum. Prototypes I, II, III, and IV. Psychiatr Clin North Am 22(3):517–534

    CAS  Article  Google Scholar 

  10. Wijeratne C, Malhi GS (2007) Vascular mania: an old concept in danger of sclerosing? A clinical overview. Acta Psychiatr Scand Suppl. https://doi.org/10.1111/j.1600-0447.2007.01057.x

    Article  PubMed  Google Scholar 

  11. Fujiwara Y, Honda T, Tanaka Y, Aoki S, Kuroda S (1998) Comparison of early- and late-onset rapid cycling affective disorders: clinical course and response to pharmacotherapy. J Clin Psychopharmacol 18(4):282–288

    CAS  Article  Google Scholar 

  12. Arnold OH, Kryspin-Exner K (1965) The problem of control of manic-depressive processes by antidepressants. Wien Med Wochenschr 115(45):929–934

    CAS  PubMed  Google Scholar 

  13. Akiskal HS, Brieger P, Mundt C, Angst J, Marneros A (2002) Temperament and affective disorders. The TEMPS-A Scale as a convergence of European and US-American concepts. Nervenarzt 73(3):262–271

    CAS  Article  Google Scholar 

  14. Sajatovic M, Blow FC, Ignacio RV, Kales HC (2004) Age-related modifiers of clinical presentation and health service use among veterans with bipolar disorder. Psychiatr Serv 55(9):1014–1021. https://doi.org/10.1176/appi.ps.55.9.1014

    Article  PubMed  Google Scholar 

  15. Goldstein BI, Herrmann N, Shulman KI (2006) Comorbidity in bipolar disorder among the elderly: results from an epidemiological community sample. Am J Psychiatry 163(2):319–321. https://doi.org/10.1176/appi.ajp.163.2.319

    Article  PubMed  Google Scholar 

  16. Sajatovic M, Kales HC (2006) Diagnosis and management of bipolar disorder with comorbid anxiety in the elderly. J Clin Psychiatry 67(Suppl 1):21–27

    PubMed  Google Scholar 

  17. Gildengers AG, Butters MA, Seligman K, McShea M, Miller MD, Mulsant BH, Kupfer DJ, Reynolds CF 3rd (2004) Cognitive functioning in late-life bipolar disorder. Am J Psychiatry 161(4):736–738. https://doi.org/10.1176/appi.ajp.161.4.736

    Article  PubMed  Google Scholar 

  18. Young RC, Murphy CF, Heo M, Schulberg HC, Alexopoulos GS (2006) Cognitive impairment in bipolar disorder in old age: literature review and findings in manic patients. J Affect Disord 92(1):125–131. https://doi.org/10.1016/j.jad.2005.12.042

    CAS  Article  PubMed  Google Scholar 

  19. Dhingra U, Rabins PV (1991) Mania in the elderly: a 5–7 year follow-up. J Am Geriatr Soc 39(6):581–583

    CAS  Article  Google Scholar 

  20. Kessing LV, Nilsson FM (2003) Increased risk of developing dementia in patients with major affective disorders compared to patients with other medical illnesses. J Affect Disord 73(3):261–269

    Article  Google Scholar 

  21. Young RC, Kiosses D, Heo M, Schulberg HC, Murphy C, Klimstra S, Deasis JM, Alexopoulos GS (2007) Age and ratings of manic psychopathology. Bipolar Disord 9(3):301–304. https://doi.org/10.1111/j.1399-5618.2007.00393.x

    Article  PubMed  Google Scholar 

  22. Young RC, Gyulai L, Mulsant BH, Flint A, Beyer JL, Shulman KI, Reynolds CF 3rd (2004) Pharmacotherapy of bipolar disorder in old age: review and recommendations. Am J Geriatr Psychiatry 12(4):342–357. https://doi.org/10.1176/appi.ajgp.12.4.342

    Article  PubMed  Google Scholar 

  23. McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR (2012) Lithium toxicity profile: a systematic review and meta-analysis. Lancet 379(9817):721–728. https://doi.org/10.1016/S0140-6736(11)61516-X

    CAS  Article  Google Scholar 

  24. McDonald WM, Nemeroff CB (1996) The diagnosis and treatment of mania in the elderly. Bull Menninger Clin 60(2):174–196

    CAS  PubMed  Google Scholar 

  25. Young RC, Mulsant BH, Sajatovic M, Gildengers AG, Gyulai L, Al Jurdi RK, Beyer J, Evans J, Banerjee S, Greenberg R, Marino P, Kunik ME, Chen P, Barrett M, Schulberg HC, Bruce ML, Reynolds CF 3rd, Alexopoulos GS, Group G (2017) GERI-BD: a randomized double-blind controlled trial of lithium and divalproex in the treatment of mania in older patients with bipolar disorder. Am J Psychiatry 174(11):1086–1093. https://doi.org/10.1176/appi.ajp.2017.15050657

    Article  PubMed  PubMed Central  Google Scholar 

  26. Shine B, McKnight RF, Leaver L, Geddes JR (2015) Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data. Lancet 386(9992):461–468. https://doi.org/10.1016/S0140-6736(14)61842-0

    CAS  Article  PubMed  Google Scholar 

  27. Gerstner T, Busing D, Bell N, Longin E, Kasper JM, Klostermann W, Hebing B, Hanefeld F, Eckel U, Hoffmann R, Bettendorf U, Weidner B, Wiemer-Kruel A, Brockmann K, Neumann FW, Sandrieser T, Wolff M, Konig S (2007) Valproic acid-induced pancreatitis: 16 new cases and a review of the literature. J Gastroenterol 42(1):39–48. https://doi.org/10.1007/s00535-006-1961-4

    CAS  Article  PubMed  Google Scholar 

  28. Robillard M, Conn DK (2002) Lamotrigine use in geriatric patients with bipolar depression. Can J Psychiatry 47(8):767–770. https://doi.org/10.1177/070674370204700808

    Article  PubMed  Google Scholar 

  29. Sajatovic M (2002) Treatment of bipolar disorder in older adults. Int J Geriatr Psychiatry 17(9):865–873. https://doi.org/10.1002/gps.719

    Article  PubMed  Google Scholar 

  30. Baruch Y, Tadger S, Plopski I, Barak Y (2013) Asenapine for elderly bipolar manic patients. J Affect Disord 145(1):130–132. https://doi.org/10.1016/j.jad.2012.05.027

    CAS  Article  PubMed  Google Scholar 

  31. Sethi MA, Mehta R, Devanand DP (2003) Gabapentin in geriatric mania. J Geriatr Psychiatry Neurol 16(2):117–120. https://doi.org/10.1177/0891988703016002010

    Article  PubMed  Google Scholar 

  32. Shulman RW, Singh A, Shulman KI (1997) Treatment of elderly institutionalized bipolar patients with clozapine. Psychopharmacol Bull 33(1):113–118

    CAS  PubMed  Google Scholar 

  33. Schneider LS, Dagerman K, Insel PS (2006) Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry 14(3):191–210. https://doi.org/10.1097/01.JGP.0000200589.01396.6d

    Article  PubMed  Google Scholar 

  34. Mueser KT, Pratt SI, Bartels SJ, Swain K, Forester B, Cather C, Feldman J (2010) Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness. J Consult Clin Psychol 78(4):561–573. https://doi.org/10.1037/a0019629

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Zentrum für Altersmedizin und Entwicklungsstörungen, kbo-Isar-Amper Klinikum, Akademisches Lehrkrankenhaus der LMU München, Vockestr. 72, 85540, Haar, Deutschland

    Jens Benninghoff &  Peter Brieger

  2. Klinik für Psychiatrie und Psychotherapie, LVR-Klinikum Essen, Kliniken und Institut der Universität Duisburg-Essen, Essen, Deutschland

    Jens Benninghoff

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  1. Jens Benninghoff
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  2. Peter Brieger
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Correspondence to Jens Benninghoff.

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J. Benninghoff und P. Brieger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Benninghoff, J., Brieger, P. Bipolare affektive Störungen im höheren Lebensalter. Z Gerontol Geriat 51, 751–757 (2018). https://doi.org/10.1007/s00391-018-1446-0

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  • DOI: https://doi.org/10.1007/s00391-018-1446-0

Schlüsselwörter

  • Eintrittsalter
  • Demenz
  • Manie
  • Lithium
  • Pharmakologie

Keywords

  • Age of onset
  • Dementia
  • Mania
  • Lithium
  • Pharmacology