Skip to main content

Correlates of disability in depressed older adults with bipolar disorder

Author/s
Ariel Gildengers, Curtis Tatsuoka, Christopher Bialko, Kristin A. Cassidy, Philipp Dines, James Emanuel, Rayan K. Al Jurdi, Laszlo Gyulai, Benoit H. Mulsant, Robert C. Young, Martha Sajatovic
Citation
Issue 3 Summer 2013
CEPiP.2013;1:332-338
Abstract

Aims To identify clinical factors associated with disability in depressed older adults with bipolar disorder (BPD) receiving lamotrigine.

Methods Secondary analysis of a multi-site, 12-week, open-label, uncontrolled study of add-on lamotrigine in 57 adults 60 years and older with BD I or II depression. Measures included the Montgomery Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Dementia Rating Scale (DRS), and WHO-Disability Assessment Scale II (WHO-DAS II).

Results Medical comorbidiy in this group of elders was substantial, with roughly 60% of subjects having disorders of the vascular, musculoskeletal/integument, and endodrine/metabolic/breast systems. We found significant relationships among mood (MADRS), medical comorbidity (CIRS-G), cognition (DRS), and disability (WHO-DAS II). More severe BPD depression, more medical comorbidity and more impaired cognition were all associated with lower functioning in BPD elders.

Conclusions Our findings fit the paradigm shift that has been occurring in BPD, supporting the notion that BPD is not solely an illness of mood but that it affects multiple domains impacting overall functioning.

Keywords: bipolar disorder, elderly, geriatric, lamotrigine, mood stabilizer, anticonvulsant, depress

Cite as: Cutting Edge Psychiatry in Practice 2013, 3(1):332-338; https://doi.org/10.65031/bsut5917

References

  1. Leboyer, M., et al., Can bipolar disorder be viewed as a multi-system inflammatory disease? Journal of Affective Disorders, In Press (0).                
  2. Leboyer, M. and D.J. Kupfer, Bipolar disorder: new perspectives in health care and prevention. J Clin Psychiatry, 2010. 71 (12): p. 1689-95. https://doi.org/10.4088/jcp.10m06347yel
  3. Wingo, A.P., et al., Factors associated with functional recovery in bipolar disorder patients. Bipolar Disord, 2010. 12 (3): p. 319-26. https://doi.org/10.1111/j.1399-5618.2010.00808.x
  4. Harvey, P.D., et al., Cognition and disability in bipolar disorder: lessons from schizophrenia research. Bipolar Disord, 2010. 12 (4): p. 364-75. https://doi.org/10.1111/j.1399-5618.2010.00831.x
  5. Kessler, R.C., et al., Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers.[see comment]. American Journal of Psychiatry, 2006. 163 (9): p. 1561-8. https://doi.org/10.1176/appi.ajp.163.9.1561
  6. Roshanaei-Moghaddam, B. and W. Katon, Premature mortality from general medical illnesses among persons with bipolar disorder: a review. Psychiatr Serv, 2009. 60 (2): p. 147-56. https://doi.org/10.1176/appi.ps.60.2.147
  7. Sajatovic, M. and F.C. Blow, Bipolar Disorder in Later Life. 2007, Baltimore: Johns Hopkins University Press. https://doi.org/10.1017/s0144686x08007307
  8. Kilbourne, A.M., The burden of general medical conditions in patients with bipolar disorder. Curr Psychiatry Rep, 2005. 7 (6): p. 471-7. https://doi.org/10.1007/s11920-005-0069-5
  9. Sajatovic, M., et al., Multisite, open-label, prospective trial of lamotrigine for geriatric bipolar depression: a preliminary report. Bipolar Disord, 2011. 13 (3): p. 294-302. https://doi.org/10.1111/j.1399-5618.2011.00923.x
  10. Gildengers, A., et al., Correlates of treatment response in depressed older adults with bipolar disorder. J Geriatr Psychiatry Neurol, 2012. 25 (1): p. 37-42. https://doi.org/10.1177/0891988712436685
  11. Bowie, C.R., et al., Prediction of real-world functional disability in chronic mental disorders: a comparison of schizophrenia and bipolar disorder. Am J Psychiatry, 2010. 167 (9): p. 1116-24. https://doi.org/10.1176/appi.ajp.2010.09101406
  12. Hamilton, M., A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960. 23 (1): p. 56-62.     
  13. Williams, J.B., et al., The GRID-HAMD: standardization of the Hamilton Depression Rating Scale. Int Clin Psychopharmacol, 2008. 23 (3): p. 120-9.
  14. Montgomery, S. and M. Asberg, A new depression scale designed to be sensitive to change. Br J Psychiatry, 1979. 134 (4): p. 382-389. https://doi.org/10.1192/bjp.134.4.382
  15. Young, R.C., et al., A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry, 1978. 133 (5): p. 429-35. https://doi.org/10.1192/bjp.133.5.429
  16. Miller, M.D., et al., Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research, 1992. 41 (3): p. 237-48. https://doi.org/10.1016/0165-1781(92)90005-n
  17. Mattis, S., Dementia Rating Scale (DRS). 1988, Odessa, FL: Psychological Assessment Resources.       
  18. Rajji, T.K., et al., The MMSE is not an adequate screening cognitive instrument in studies of late-life depression. Journal of Psychiatric Research, 2009. 43 (4): p. 464-470. https://doi.org/10.1016/j.jpsychires.2008.06.002
  19. Epping-Jordan, J.A. and T.B. Ustun, The WHODAS-II: level the playing field fo all disorders. Bull WHO, 2000 (6): p. 5-6.         
  20. Lala, S.V. and M. Sajatovic, Medical and psychiatric comorbidities among elderly individuals with bipolar disorder: a literature review. J Geriatr Psychiatry Neurol, 2012. 25 (1): p. 20-5. https://doi.org/10.1177/0891988712436683
  21. Krishnan, K.R., Psychiatric and medical comorbidities of bipolar disorder. Psychosom Med, 2005. 67 (1): p. 1-8. 
  22. Nunes, P.V., O.V. Forlenza, and W.F. Gattaz, Lithium and risk for Alzheimer’s disease in elderly patients with bipolar disorder. The British Journal of Psychiatry, 2007. 190 (4): p. 359-360. https://doi.org/10.1192/bjp.bp.106.029868
  23. Kales, H., Medical Comorbidity in Late-Life Bipolar Disorder, in Bipolar Disorder in Later Life, M. Sajatovic and F.C. Blow, Editors. 2007, Johns Hopkins University Press: Baltimore. https://doi.org/10.1017/s0144686x08007307
  24. McIntyre, R.S., et al., Medical Comorbidity in Bipolar Disorder: Implications for Functional Outcomes and Health Service Utilization. Psychiatr Serv, 2006. 57 (8): p. 1140-1144. https://doi.org/10.1176/appi.ps.57.8.1140
  25. McIntyre, R.S., et al., Bipolar disorder and diabetes mellitus: epidemiology, etiology, and treatment implications. Annals of Clinical Psychiatry, 2005. 17 (2): p. 83-93. https://doi.org/10.1080/10401230590932380
  26. CDC, Trends in aging--United States and worldwide. MMWR Morb Mortal Wkly Rep, 2003. 52 (6): p. 101-4, 106.                 
  27. Jeste, D.V., et al., Consensus statement on the upcoming crisis in geriatric mental health: research agenda for the next 2 decades. Arch Gen Psychiatry, 1999. 56 (9): p. 848-53. https://doi.org/10.1001/archpsyc.56.9.848