Clinical Characteristics of Patients with Late Life Bipolar Disorder in the Community: Data from the NNDC Registry
Brent P. Forester, M.D., M.Sc., Olu Ajilore, M.D., Ph.D., Cathie Spino, D.Sc., Susan W. Lehmann, M.D.
Objective: To compare clinical characteristics of older and younger patients with bipolar disorder enrolled in the United States’ National Network of Depression Centers (NNDC) Clinical Care Registry (CCR). Design: Multicenter, de-identified naturalistic data from the National NNDC’s CCR for all patients with a diagnosis of bipolar disorder who were enrolled in the registry as of April 25, 2013. Participants: Community-dwelling patients (N ¼ 218), ages 18 years or older, with bipolar disorder diagnosis recruited by NNDCaffiliated medical centers to participate in the NNDC CCR. Subjects aged 55 years or older were compared with subjects younger than age 55 years on clinical measures. Measurements: Patient Health Questionnaire; Quick Inventory of Depressive Symptomatology – Self-Report; Altman Self-Rating Mania Scale; Work and Social Adjustment Scale; Frequency and Intensity of Burden of Side Effects Rating; and the SelfAdministered Comorbidity Questionnaire. Results: A greater percentage of older patients were prescribed antidepressant medications (71.9% versus 50.0%), and the younger cohort had significantly more psychostimulant use (16.7% versus 0%). Younger patients endorsed significantly more depressive symptoms compared with older patients. The mean number of psychotropic medications was not different in both older and younger patients with bipolar disorder. There was no statistically significant difference in frequency, intensity, or burden of psychotropic medication side effects as measured by the Frequency and Intensity of Burden of Side Effects Rating. Conclusion: Findings of higher antidepressant use rates in the older cohort, combined with lower depression symptom severity and a similar degree of manic symptoms, suggests the possibility that older adults with bipolar disorder may have improved antidepressant efficacy and lower switch rates into manic or mixed states compared with younger cohorts. Ongoing data collection by the NNDC CCR will add to current knowledge to inform the care of older patients with bipolar disorder by providing multi-site data regarding phenomenology, treatment response, and longitudinal course of late life bipolar disorder in community settings. (Am J Geriatr Psychiatry 2015; 23:977e984)
Key Words: Bipolar, geriatric, community, phenomenology, registry
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