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Mania compared with unipolar depression in old age.
K I Shulman1, M Tohen, A Satlin
1McLean Hospital, Belmont, Mass.
The American Journal of Psychiatry
|March 1, 1992
Summary
Late-onset mania in the elderly indicates a poorer prognosis and more severe illness compared to unipolar depression. Differentiating early- from late-onset mania is crucial for understanding outcomes in geriatric affective disorders.
Area of Science:
- Geriatric Psychiatry
- Affective Disorders
- Neurology
Background:
- Mania in old age is not well understood.
- Distinguishing late-onset mania from other affective disorders is clinically important.
Purpose of the Study:
- To clarify the meaning and importance of mania in elderly patients.
- To compare the clinical course and outcomes of mania versus unipolar depression in the elderly.
Main Methods:
- Retrospective study of 50 elderly patients with mania and 50 with unipolar depression.
- Chart review for family history, clinical course, and neurological disorders.
- Survival analysis to compare mortality rates.
Main Results:
- Manic patients had a stronger family history of affective disorder and earlier first psychiatric hospitalization.
- 18 manic patients had neurological disorders, compared to 4 depressed patients.
- Manic patients had a significantly higher mortality rate (25 deaths vs. 10 deaths).
Conclusions:
- Late-onset mania suggests a more severe affective illness with a poorer prognosis than unipolar depression.
- Neurological disorders in manic patients may indicate secondary mania.
- Subtle cerebral changes or a long latency from depression to mania in the elderly warrants further investigation.