title: Bipolar disorder in the elderly; different effects of age and of age of onset.
abstract: BACKGROUND
  Information about differences between younger and elderly patients with bipolar disorder and between elderly patients with early and late age of onset of illness is limited.
  
  
  METHODS
  The European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study was a 2-year prospective, observational study in 3459 bipolar patients on the treatment and outcome of patients with an acute manic or mixed episode. Within this study, elderly patients (>60 years of age; n=475) were compared with younger patients (<50 years of age; n=2286), and within the elderly group, Late Onset Bipolar (LOB) patients (onset > or =50 years; n=141) were compared with Early Onset Bipolar (EOB) patients (<50 years; n=323).
  
  
  RESULTS
  In the year prior to enrollment, elderly patients, especially those with EOB, more frequently reported a rapid cycling course of illness, but fewer suicide attempts. At baseline, elderly patients more often used one psychotropic medication and demonstrated less severe manic and psychotic symptoms, but no difference in depressive symptomatology. However, prior to enrollment and during the acute phase of treatment, elderly patients more frequently received antidepressants. Atypical antipsychotics were given less frequently. Regarding 12-week outcomes, there was no difference between elderly and younger patients, although LOB elderly recovered faster, and were discharged sooner than EOB elderly patients.
  
  
  CONCLUSIONS
  Information about somatic conditions was not systematically collected nor was information about concurrent use of non-psychiatric medication which might have given some indication of somatic comorbidity.
  
  
  CONCLUSIONS
  Elderly bipolar manic patients differ from younger bipolar manic patients regarding treatment but not treatment outcome. LOB elderly patients demonstrated a more favourable outcome. The use of medication and the occurrence of rapid cycling in EOB elderly patients warrant further study.
authors.affiliation: GGZ Haagstreek Department of Psychiatry, Leidschendam, The Netherlands. f.oostervink@ggzhaagstreek.nl
authors.forename: Frits
authors.initials: F
authors.lastname: Oostervink
authors.forename: Maarten M
authors.initials: MM
authors.lastname: Boomsma
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003702:Delusions / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D014150:Antipsychotic Agents