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Late life mood disorders

Maria Ly, Carmen Andreescu
PURPOSE OF REVIEW: Mood and anxiety disorders are very commonly experienced by older adults and are becoming a growing concern due to the rapidly aging global population. Recent advances in neuroimaging may help in improving outcomes in late-life mood and anxiety disorders. The elucidation of mechanisms contributing to late-life mental health disorders may ultimately lead to the identification of novel therapeutic interventions. Alternatively, clinically validated imaging biomarkers may allow for the prediction of treatment response and identification of better therapeutic approaches in late-life mood and anxiety disorders...
March 1, 2018: Current Psychiatry Reports
Kelsey T Laird, Pattharee Paholpak, Michael Roman, Berna Rahi, Helen Lavretsky
PURPOSE OF REVIEW: A growing body of research supports the use of mind-body therapies (MBTs) as minimally invasive and effective approaches for the management of late-life mood and cognitive disorders. RECENT FINDINGS: Recent randomized controlled trials and meta-analyses indicate that MBTs are effective for enhancing well-being, mood, sleep, and cognition in older adults. Evidence suggests that mindful movement (e.g., yoga, tai chi, walking meditation) may even outperform conventional physical exercise with regard to effects on quality of life, mood, and cognitive functioning...
January 25, 2018: Current Psychiatry Reports
Sophie R Vaccarino, Tarek K Rajji, Ariel G Gildengers, Sarah E S Waters, Meryl A Butters, Mahesh Menon, Daniel M Blumberger, Aristotle N Voineskos, Dielle Miranda, Benoit H Mulsant
OBJECTIVE: Older patients with bipolar disorder (BD) present with variable degrees of cognitive impairment. Over time, stress, mood episodes, and comorbidities increase the body's allostatic load. We assessed the extent to which allostatic load vs more traditional measures of medical burden account for the heterogeneity in cognition in this population. METHODS: Thirty-five older euthymic patients with BD and 30 age-equated, gender-equated, and education-equated comparison participants were administered a comprehensive assessment including a neuropsychological battery, and 9 physiological measures to determine allostatic load...
December 13, 2017: International Journal of Geriatric Psychiatry
Annemiek Dols, Nicole Korten, Hannie Comijs, Sigfried Schouws, Moniek van Dijk, Ursula Klumpers, Aartjan Beekman, Ralph Kupka, Max Stek
OBJECTIVES: Little is known about the course of late-life bipolar disorder (LLBD). First, we studied patients with LLBD retrospectively with regard to age at first mood episode, onset polarity, predominant polarity and episode density and its associations with other clinical variables. Next, we examined prospectively the clinical course and its associated factors. METHODS: Data were used from a dynamic cohort (Dutch Older Bipolars [DOBi]) including 101 patients with LLBD (mean age of 68...
December 11, 2017: Bipolar Disorders
Liana K Mathias, Patrick J Monette, David G Harper, Brent P Forester
The prevalence of mood disorders in the rapidly-growing older adult population merits attention due to the likelihood of increased medical comorbidities, risk of hospitalization or institutionalization, and strains placed on caregivers and healthcare providers. Magnetic resonance spectroscopy (MRS) quantifies biochemical compounds in vivo, and has been used specifically for analyses of neural metabolism and bioenergetics in older adults with mood disorders, usually via proton or phosphorous spectroscopy. While yet to be clinically implemented, data gathered from research subjects may help indicate potential biomarkers of disease state or trait or putative drug targets...
December 2017: International Review of Psychiatry
Robert C Young, Benoit H Mulsant, Martha Sajatovic, Ariel G Gildengers, Laszlo Gyulai, Rayan K Al Jurdi, John Beyer, Jovier Evans, Samprit Banerjee, Rebecca Greenberg, Patricia Marino, Mark E Kunik, Peijun Chen, Marna Barrett, Herbert C Schulberg, Martha L Bruce, Charles F Reynolds, George S Alexopoulos
OBJECTIVE: Clinicians treating older patients with bipolar disorder with mood stabilizers need evidence from age-specific randomized controlled trials. The authors describe findings from a first such study of late-life mania. METHOD: The authors compared the tolerability and efficacy of lithium carbonate and divalproex in 224 inpatients and outpatients age 60 or older with bipolar I disorder who presented with a manic, hypomanic, or mixed episode. Participants were randomly assigned, under double-blind conditions, to treatment with lithium (target serum concentration, 0...
November 1, 2017: American Journal of Psychiatry
Elizabeth Cort, Jennifer Meehan, Suzanne Reeves, Robert Howard
Psychosis symptoms (delusions and hallucinations) are multifactorial in origin and, in later life, occur in the context of schizophrenia, delirium, dementia, delusional and schizophrenia-like disorders, mood disorders, and alcohol or substance abuse. The current article provides a clinical overview of very late-onset (after age 60) schizophrenia-like psychosis (VLOSLP), summarizing the literature on treatment options and reflecting on the role of psychiatric-mental health nurses (PMHNs). Increased awareness of the clinical presentation, key features, and evidence-based treatment options will assist PMHNs to confidently recognize this often under-diagnosed disorder and adopt a more assertive role in terms of engagement and follow up...
January 1, 2018: Journal of Psychosocial Nursing and Mental Health Services
Amanda M Mitchell, Kyle Porter, Lisa M Christian
OBJECTIVE: Childhood trauma is associated with negative perinatal health outcomes including mood disorders and shorter gestation. However, effects of early life exposures on maternal biology are poorly delineated. This study examined associations between childhood trauma and inflammation, as well as the mediating role of obesity in this relationship. METHOD: This study examined a racially diverse sample of 77 pregnant women assessed in early, mid, and late pregnancy...
October 2, 2017: Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association
Michy P Kelly
The most recently discovered 3',5'-cyclic nucleotide phosphodiesterase family is the Phosphodiesterase 11 (PDE11) family, which is encoded by a single gene PDE11A. PDE11A is a dual-specific PDE, breaking down both cAMP and cGMP. There are four PDE11A splice variants (PDE11A1-4) with distinct tissue expression profiles and unique N-terminal regulatory regions, suggesting that each isoform could be individually targeted with a small molecule or biologic. PDE11A4 is the PDE11A isoform expressed in brain and is found in the hippocampal formation of humans and rodents...
2017: Advances in Neurobiology
Elizabeth A Crocco, Sindy Jaramillo, Caroline Cruz-Ortiz, Katherine Camfield
Anxiety disorders are common in the elderly. Additionally, anxiety symptoms often accompany co-morbid psychiatric, medical, as well as neurodegenerative diseases in the older population. Anxiety in the elderly, often accompanied by depression, can lead to worsening physical, cognitive and functional impairments in this vulnerable population. Antidepressants are considered first line treatment. Both SSRIs and SNRIs are efficacious and well-tolerated in the elderly. Some SSRIs are strong inhibitors of the cytochrome P450 hepatic pathway whereas others have less potential for drug interaction...
March 2017: Current Treatment Options in Psychiatry
Jianjun Wang, Jinfang Li, Fanxin Kong, Hanqing Lv, Zhouke Guo
Mood disturbances have been documented in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The highly varied morbidity indicates that the affective symptoms in CADASIL have not been cataloged systematically, leading to ineffective treatment, affecting the patients' quality of life, and possibly resulting in suicide. We present a case of CADASIL with bipolar II disorder as the first manifestation. A middle-aged female reported recurrent depressive episodes and appeared treatment resistant to adequate dosages and durations of antidepressants...
2017: Neuropsychiatric Disease and Treatment
Gretchen A Brenes, Suzanne C Danhauer, Mary F Lyles, Andrea Anderson, Michael E Miller
OBJECTIVE: To examine the long-term effects of telephone-delivered cognitive-behavioral therapy (CBT-T) compared with nondirective supportive therapy (NST-T) in rural older adults with generalized anxiety disorder (GAD). METHODS: 141 adults aged 60 years and older with a principal/co-principal diagnosis of GAD were randomized to either CBT-T or NST-T. CBT-T consisted of up to 11 sessions (9 were required) focused on recognition of anxiety symptoms, relaxation, cognitive restructuring and use of coping statements, problem-solving, worry control, behavioral activation, exposure therapy, and relapse prevention, with optional chapters on sleep and pain...
November 2017: American Journal of Geriatric Psychiatry
Kathleen G Hopkins, Peter F Ferson, Manisha R Shende, Neil A Christie, Matthew J Schuchert, Arjun Pennathur
BACKGROUND: Surgical resection with curative-intent remains the gold standard for clinically operable early-stage non-small cell lung cancer (NSCLC). This goal can be accomplished using a minimally invasive option, e.g., video assisted thoracic surgery (VATS) or standard thoracotomy. Surgical techniques continue to evolve and few studies have compared the QOL of patients managed with these procedures using current approaches. The primary goal of this study was to investigate differences between patients managed surgically via VATS compared to thoracotomy with respect to ratings of chronic pain, anxiety/depression and quality of life (QOL)...
May 2017: Annals of Translational Medicine
Patricia Marino, Herbert C Schulberg, Ariel G Gildengers, Benoit H Mulsant, Martha Sajatovic, Laszlo Gyulai, Rayan K Aljurdi, Laurie Davan Evans, Samprit Banerjee, Ruben C Gur, Robert C Young
INTRODUCTION: The evidence base regarding characteristics of older adults with bipolar disorder (BD) remains limited. The NIH-funded multicenter study Acute Pharmacotherapy of Late-Life Mania (GERI-BD) assessed various clinical domains before and during mood stabilizer treatment in older adults participating in a 9-week, double-blind randomized controlled trial. We describe the rationale for selecting these instruments. METHODS: Domains and instruments were selected on the basis of the study design and the participants...
January 2018: International Journal of Geriatric Psychiatry
Davide Zarcone, Simona Corbetta
Since the nineteenth century several clinical features have been observed in common between migraine and epilepsy (such as episodic attacks, triggering factors, presence of aura, frequent familiarity), but only in recent years researchers have really engaged in finding a common pathogenic mechanism. From studies of disease incidence, we understand how either migraine among patients with epilepsy or epilepsy among migraine patients are more frequent than in the general population. This association may result from a direct causality, by the same environmental risk factors and/or by a common genetic susceptibility...
May 2017: Neurological Sciences
Harris Eyre, Prabha Siddarth, Natalie Cyr, Hongyu Yang, Steve Cole, Malcolm Forbes, Helen Lavretsky
Vilazodone is a novel antidepressant agent that combines selective serotonin (5-HT) reuptake inhibitor (SSRI) activity and 5-HT(1A) receptor partial agonist activity. A pilot study was conducted to compare vilazodone (novel compound) and paroxetine (gold standard) on antidepressant effects, tolerability, and inflammation and immune modulation. A 12-week, double-blind, randomized clinical trial was conducted with 56 nondemented older adults diagnosed with major depressive disorder (MDD). Between-group differences in mood, tolerability, and safety, as well as genomic markers of inflammation and immune modulation, were examined...
November 2017: Pharmacopsychiatry
A-I Gasser, V Salamin, S Zumbach
INTRODUCTION: Depression and Alzheimer's disease are both very frequent in elderly people. Cognitive deficits are the hallmark of Alzheimer's disease, but they are also common in depressed elderly people who often present cognitive deficits such as memory, attention and executive function problems. On the other hand, people with early Alzheimer's disease demonstrate emotional and behavioral disorders generally encountered in depression such as loss of energy, apathy, mood disorder, and irritability...
April 20, 2017: L'Encéphale
R M Collard, M H L Arts, A H Schene, P Naarding, R C Oude Voshaar, H C Comijs
BACKGROUND: Physical frailty and depressive symptoms are reciprocally related in community-based studies, but its prognostic impact on depressive disorder remains unknown. METHODS: A cohort of 378 older persons (≥60 years) suffering from a depressive disorder (DSM-IV criteria) was reassessed at two-year follow-up. Depressive symptom severity was assessed every six months with the Inventory of Depressive Symptomatology, including a mood, motivational, and somatic subscale...
January 24, 2017: European Psychiatry: the Journal of the Association of European Psychiatrists
Pasquale De Fazio, Raffaele Gaetano, Mariarita Caroleo, Maria Pavia, Giovanbattista De Sarro, Andrea Fagiolini, Cristina Segura-Garcia
The prevalence of mania among >65-year-olds ranges from 0.1% to 0.4% and its treatment is a particular challenge for clinicians. Although lithium is the treatment of choice for bipolar disorder (BD), its use in elderly population was recently questioned. This study provides a comprehensive review of literature on the efficacy and tolerability of lithium as a pharmacologic treatment for mania in elderly BD patients. We conducted a systematic review, based on PRISMA guidelines, of articles published between 1970 and August 2016 and indexed in the following databases: EMBASE, MEDLINE, Cochrane Library Databases and PsycINFO...
2017: Neuropsychiatric Disease and Treatment
Sarah T Stahl, Charles F Reynolds, Ellen M Whyte, Steven M Albert
OBJECTIVES: To compare the prevalence of psychiatric diagnoses among older recipients of publicly funded mental health services (county safety-net base services and Medicaid) to psychiatric diagnoses in an insured population of older adults from the same county. DESIGN: Secondary analysis of county human services claims data and claims from an insured population in the same county. SETTING: Inpatient and outpatient clinics in Allegheny County, PA...
July 2017: Journal of the American Geriatrics Society
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