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Depression symptom ratings in geriatric patients with bipolar mania

Authors

  • Martha Sajatovic,

    Corresponding author
    1. Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
    • Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
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  • Rayan Al Jurdi,

    1. Department of Psychiatry, The Menninger Department of Psychiatry at Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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  • Ariel Gildengers,

    1. Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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  • Rebecca L. Greenberg,

    1. Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
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  • Thomas Tenhave,

    1. Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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  • Martha L. Bruce,

    1. Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
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  • Benoit Mulsant,

    1. Geriatric Mental Health Program, Center for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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  • Robert C. Young

    1. Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
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    • Other contributing members of the Geri-BD study team are Alexopoulos GS, Beyer J, Evans JD, Gur R, Gyulai L, Kunik M, Marangall L, Marino P, Reynolds CF, Shulberg HC.


  • Portions of this data have been presented at the International Congress on Bipolar Disorder (ISBD), 25–28 June 2009, Pittsburgh, Pennsylvania and the 9th World Congress of Biological Psychiatry (WFSBP), 28 June–2 July, Paris, France.

Abstract

Objective

Given the paucity of information available regarding standardized ratings of depression symptoms in bipolar manic states, and in particular those in older adults, we explored depression ratings in symptomatic participants in a multicenter study of treatment of bipolar I disorder in late life.

Methods

Baseline data was obtained from the first 100 patients enrolled in an NIMH-funded, 9-week, randomized, double-blind RCT comparing treatment with lithium or valproate in patients of age 60 years and older with Type I Bipolar mania or hypomania. This multi-site study was conducted at six academic medical centers in the United States and enrolled inpatients and outpatients with a total Young Mania Rating Scale (YMRS) score of 18 or greater. Depressive symptoms were evaluated with the Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS). The criterion for at least moderate bipolar depressive symptoms was the European College of Neuropsychopharmacology (ECNP) Consensus Meeting definition of HAM-D 17 total score >20.

Results

Eleven percent of patients had mixed symptoms defined by depression scale severity according to ECNP criterion. In the overall sample, total scores on the two depression scales were highly correlated. Total YMRS scores of this mixed symptom group were similar to the remainder of the sample.

Conclusions

These preliminary findings suggest that moderate to severe depressive symptoms occur in about one in ten bipolar manic elders. Future studies are needed to further evaluate symptom profiles, clinical correlates, and treatments for bipolar older adults with combined manic and depressive symptoms. Copyright © 2011 John Wiley & Sons, Ltd.

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