Phenomenology and comorbidity in late onset bipolar disorder: A comparative study

OBJECTIVE-: 1. To assess the clinical characteristics of late onset bipolar disorder and to compare with adult onset bipolar disorder and 2. To compare the medical co morbidity between age, sex matched healthy control group. MATERIAL & METHOD: – It was a hospital based, observational, analytical and cross-sectional study conducted in department of Psychiatry in a tertiary care centre. The patients > 60 years presenting with manic features after satisfying the inclusion and exclusion criteria were included in the study group. Control group -1 was selected from patients of adult onset bipolar disorder. YMRS, MMSE were applied for participants in all the groups. Control group -2 was selected from age, sex, education matched normal population and the three groups were compared for co morbidity. Secondary mania cases are excluded from the study. RESULTS: – Mean age at onset in the study group was 67.4 years. 63.3% of our patients were female. H/O psychiatric illness in family was more in the control group 1 (53.3%) than in study group (26.7%) (p=0.035). while studying the clinical characteristics, it was found that 86.6% patients in the study group presented with irritability, 73.3% patients were presented with aggression. Whereas in the control group 1 irritability was found in 90%, aggression75%. The difference is not statistically significant. However, the scoring of each symptom showed significant difference. It means presence & severity of delusion is significantly more in young bipolar control group. (p=0.035 for % score, p=0.015 for mean SAPS score). 70% presented with co morbidities. CONCLUSION: – Geriatric mania shows mixed presentation compared to early onset disease. Psychotic features are more common. Late onset mania is less associated with family history. Common co morbidities are DM, HTN, Hypothyroidism, neurologic disorders.