Biomarkers of Bipolar Disorder in Late Life: An Evidence-Based Systematic Review.

PURPOSE OF REVIEW: Review the current evidence on biomarkers for bipolar disorder in the older adults. We conducted a systematic search of PubMed MEDLINE, PsycINFO, and Web of Science databases using the MeSH search terms "Biomarkers", "Bipolar Disorder", "Aged" and and "Aged, 80 and over". Studies were included if they met the following criteria: (1) the mean age of the study population was 50 years old or older, (2) the study included patients with bipolar disorder, and (3) the study examined one type of biomarkers or more including genetic, neuroimaging, and biochemical biomarkers. Reviews, case reports, studies not in English and studies for which no full text was available were excluded. A total of 26 papers were included in the final analysis. RECENT FINDINGS: Genomic markers of bipolar disorder in older adults highlighted the implication of serotonin metabolism, while the expression of genes involved in angiogenesis was dysregulated. Peripheral blood markers were mainly related with low grade inflammation, axonal damage, endothelial dysfunction, and the dysregulation of the HPA axis. Neuroanatomical markers reflected a dysfunction of the frontal cortex, a loss of neurones in the anterior cingulate cortex and a reduction of the hippocampal volume (in patients older than 50 years old). While not necessarily limited to older adults, some of them may be useful for differential diagnosis (neurofilaments), disease staging (homocysteine, BDNF) and the monitoring of treatment outcomes (matrix metalloproteinases). Our review provides a comprehensive overview of the current evidence on biomarkers for bipolar disorder in the older adults. The identification of biomarkers may aid in the diagnosis, treatment selection, and monitoring of bipolar disorder in older adults, ultimately leading to improved outcomes for this population. Further research is needed to validate and further explore the potential clinical utility of biomarkers in this population.

Comparative analysis between the MMSE and the RUDAS for dementia screening in low educated people in a Spanish psychogeriatric clinic

BACKGROUND AND OBJECTIVES: The Mini-Mental State Examination (MMSE) remains the most widely used test for the screening of dementia, but its limitations in low educated people are well known. This justified the development of new scales aimed at rooting out any socio-cultural bias, such as the Rowland Universal Dementia Assessment Scale (RUDAS). The aim of this paper is to compare the accuracy of the Spanish RUDAS and the MMSE for the diagnosis of dementia in a population with low level of education. METHODS: In a Psychogeriatric Unit a total of 97 outpatients were administered the RUDAS (by blinded examiners) and the MMSE (by an expert clinician, blind to the RUDAS results). RESULTS: 35 of the 97 subjects received the diagnosis of dementia. The area under the ROC curve (AUC) for the RUDAS, 0.901 (IC 95% 0.84-0.96) was similar to MMSE AUC 0.889 (IC 95% 0.82-0.95). The ideal cut-off point for the RUDAS was 21/22 with 94.3% sensitivity and 72.6% specificity. The "best" cut point for the MMSE was 16/17, lower than the standard 23/24, with 85.7% sensitivity and 77.4% specificity. The MMSE correlated with educational level (r=0.432, p < 0.01), but the RUDAS did not (r=0.087; n.s.). CONCLUSIONS: The RUDAS was not only as accurate as the MMSE for the screening of dementia, but also, it was found to be free of biases associated withed the education level. Hence, the RUDAS seems to be a more adequate test for dementia screening in our cultural context than the MMSE. These results should be replicated in a primary care setting

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A review of the natural course of bipolar disorders (manic-depressive psychosis) in the pre-drug era: review of studies prior to 1950.

A review of the most important original studies describing the natural course of bipolar disorder (manic-depressive psychosis) published in the pre-drug era - before 1950 - is conducted. Discrepancies among studies are detected, most of which are likely explained by methodological differences. However, some conclusions from these old studies remain perfectly valid nowadays: mania is a chronic brain disorder, inherited in most cases, decompensation being more frequent between March and August. It is more common in males, and in some cases, is secondary to other somatic problems. Mixed states are more frequent in the elderly. The review of this type of historical studies is aimed at underscoring the importance that should be attached to the careful study of psychopathology and its recording, both in clinical practice and in psychiatry research.

Diferencias clínicas en la depresión según la clase social / Clinical differences in depression according to social class

Los objetivos del estudio fueron: a) determinar si había diferencias en la semiología depresiva según la clase social (CS); b) averiguar si estas diferencias, en caso de existir, se debían fundamentalmente a la CS o más bien a otras variables clínicas o sociodemográficas. Se estudiaron 140 pacientes ambulatorios de Galicia con el CET-DE, el 61 por ciento rurales, diagnosticados de depresión según criterios DSM-III-R. Se elaboró una escala de CS a partir de la ocupación del cabeza de familia, los ingresos familiares y los estudios del paciente. Los pacientes de los niveles inferiores de CS referían con mayor frecuencia síntomas físicos y ansiedad; y los de las superiores, deterioro cognitivo y culpa. En el análisis logístico se observó que las variables socioeconómicas y la residencia eran las que en mayor medida explicaban estas diferencias (AU)

Propuesta de una escala de clase social destinada a pacientes con depresión / Proposal of a social class scale destined to depresive patients

Se elaboró una escala de cinco niveles de clase social con la ocupación del cabeza de familia, el nivel de estudios del paciente y los ingresos familiares. Los objetivos del estudio fueron determinar si la clase social elaborada es representativa de los factores socioeconómicos y útil para el estudio de las diferencias clínicas en pacientes con depresión en Galicia.Se estudiaron 140 pacientes diagnosticados de depresión (DSM-III-R), 60,7 por ciento del medio rural. La escala de clase social se asoció de forma significativa con todas las variables e indicadores socioeconómicos (p <0,001), excepto con la proporción entre dormitorios y personas.La clase social elaborada y los estudios, fueron las variables con las que mayores diferencias clínicas se apreciaron.La escala de clase social elaborada cumplió los objetivos para los que fue diseñada. Al estudiar la clase social en pacientes con depresión es preferible utilizar una escala multidimensional (AU)