Outcome of bipolar disorder on long-term treatment with lithium
Article Abstract:
Lithium carbonate is a naturally-occurring substance that is useful in controlling the mood swings associated with bipolar disorder, formerly known as manic-depression. It is the treatment of choice in most cases. However, a significant number of patients still have poor a outcome, which is often attributed to the presence of particularly rapid mood swings and to non-compliance with lithium treatment. A particularly good outcome has been seen in patients with a family history of mania. The outcome of long-term treatment of bipolar disorder with lithium is influenced by several factors. Data for the present study was extracted from a long-term investigation of bipolar patients treated with lithium. The 20-year outcome of 248 patients was assessed using historical and demographic data, medical records, and interviews with patients, families, and friends. Assessment also included the completion of several scales rating psychopathology, social adjustment, general medical health, and incidence of bipolar illness. About 56 percent of the 248 patients had no manic-depressive episodes in the year prior to the present investigation. Overall, outcome of 40 percent of the patients was rated as good; 41 percent had a fair outcome; and 19 percent were considered to have a poor outcome. The best predictor of poor outcome was the number of hospital admissions for bipolar disorder prior to beginning lithium treatment; current substance abuse played a role as well. Families of these patients were of lower social class than those in other outcome groups, and there was a pervasive family history of negativity. There was evidence for social and demographic factors in predicting the outcome. However, the poor response of approximately 20 percent of bipolar patients treated with lithium, marked by the recurrence of manic or depressive episodes, indicates possible physiologic differences. Further genetic and neurologic research is recommended, as well as the consideration of alternative drug therapies. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Psychiatry
Subject: Health
ISSN: 0007-1250
Year: 1991
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Sex differences in the age of onset of bipolar affective illness
Article Abstract:
Psychiatric hospitals and clinics in the UK are required to submit information about in-patients to the Department of Health, including diagnosis, age, and sex. Diagnoses are based on criteria from the latest edition of the World Health Organization's International Classification of Diseases (ICD-9). The number of first admissions by age and sex for the ICD-9 category of manic-depressive psychosis, manic type between 1982 and 1986 was computed to determine if there were any sex-related differences in the age of onset. The ICD-9 places manic-depressive psychosis, manic type under the category of affective (mood) psychoses. The disorder is characterized by states of elation or excitement out of keeping with the patient's circumstances, and varies from hypomania (enhanced liveliness) to violent and uncontrollable excitement, with a susceptibility to aggression and anger, distractibility, grandiose ideas, and impaired judgment. Previous studies of sex differences in manic-depressive disorder found that more women than men were affected. Analysis of the data in this study demonstrated that between the ages of 10 to 29 years, the rate of onset was nearly equal between the sexes. From age 30 through age 54, females had a notably higher inception rate than males. However, when the overall population age distribution of men and women was taken into account, there was no difference found in the rate of bipolar affective disorder between the sexes. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Psychiatry
Subject: Health
ISSN: 0007-1250
Year: 1990
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A retrospective case-note study of bipolar disorder in old age
Article Abstract:
Some evidence suggests that the incidence of bipolar affective disorder (manic-depressive illness) decreases with age. Previous studies have reported an average age of onset in the second decade of life and that the disease rare occurs after age 60. There have been studies, however, that have reported contradictory results. In an effort to replicate findings that many elderly patients have a significant incidence of the disease, 75 elderly inpatients with bipolar affective disorder were identified and records were reviewed for age of onset of the first symptoms of their illness. There were 52 women and 23 men in this sample, all over 60 years of age. The average age of onset of first symptoms was age 46.5 years; for men the average age was 52.7 years and for women 43.7 years. Very few subjects showed evidence of symptoms prior to age 40. In 13 subjects, head injury preceded the first manic episode; for this group, a family history of mental illness was less common than for those who did not have a history of head injury. In general, bipolar illness is thought to correlate with a family history of mental illness. These results support research that suggests the incidence of onset of bipolar illness in old age may be under-recognized. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Psychiatry
Subject: Health
ISSN: 0007-1250
Year: 1991
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