Edad de inicio como marcador de subtipos de enfermedad maniacodepresiva

Información del artículo

Resumen

Introducción

En los trastornos bipolares, la edad de inicio se ha sugerido como una variable que puede asociarse con diferentes subtipos clínicos.

Objetivo

Identificar patrones en la distribución de la edad de inicio de la enfermedad bipolar y determinar si la edad de inicio se asocia con características clínicas específicas.

Métodos

Se usó análisis de distribuciones normales mezcladas para identificar subtipos de trastorno bipolar de acuerdo con la edad de inicio. Se aplicó la escala EMUN para evaluar las características clínicas y se estimaron componentes principales para evaluar la relación entre subtipos, según edad de inicio y síntomas en la fase aguda de la enfermedad, utilizando análisis multivariables.

Resultados

De acuerdo con la edad de inicio, se encontraron tres distribuciones: inicio temprano: 17,7 años (S. D. 2,4); inicio intermedio: 23,9 años (S. D. 5,6); inicio tardío: 42,8 años (S. D. 12,1). El grupo de inicio tardío es asocial, con síntomas depresivos, trastornos del pensamiento y el lenguaje, y comportamientos socialmente peligrosos.

Conclusión

En pacientes con enfermedad bipolar, la edad de inicio es asocial, con tres grupos que tienen características clínicas específicas.

Palabras clave:

Edad

predisposición genética

prevalencia

distribución sexual

factores sexuales

trastorno bipolar

Abstract

Introduction

Age at onset of bipolar disorder has been reported as a variable that may be associated with different clinical subtypes.

Objective

To identify patterns in the distributions of age at onset of bipolar disease and to determine whether age at onset is associated with specific clinical characteristics.

Methods

Admixture analysis was applied to identify bipolar disorder subtypes according to age at onset. The EMUN scale was used to evaluate clinical characteristics and principal components were estimated to evaluate the relationship between subtypes according to age at onset and symptoms in the acute in the acute phase, using multivariable analyses.

Results

According to age at onset, three distributions have been found: early onset: 17.7 years (S.D. 2.4); intermediate-onset: 23.9 years (S.D. 5.6); late onset: 42.8 years (S.D. 12.1). The late-onset group is antisocial, with depressive symptoms, thinking and language disorders, and socially disruptive behaviors.

Conclusions

In patients having bipolar disorder, age at onset is antisocial with three groups having specific clinical characteristics.

Key words:

Age

genetic predisposition

prevalence

sex distribution

sex factors

bipolar disorder

El Texto completo está disponible en PDF

Referencias

[1]

M Leboyer, C Henry, ML Paillere-Martinot, et al.

Age at onset in bipolar affective disorders: a review.

Bipolar Disord, 7 (2005), pp. 111-118

http://dx.doi.org/10.1111/j.1399-5618.2005.00181.x | Medline

[2]

O Rangel, R Sánchez.

Estudio de la estructura latente del síndrome maníaco mediante técnicas de escalamiento multidimensional.

Rev Colomb Psiquiatr, 39 (2010), pp. 240-250

[3]

HS Akiskal, JM Azorin, EG Hantouche.

Proposed multidimensional structure of mania: beyond the euphoricdysphoric dichotomy.

J Affect Disord, 73 (2003), pp. 7-18

Medline

[4]

AC Swann, PL Janicak, JR Calabrese, et al.

Structure of mania: depressive, irritable, and psychotic clusters with different retrospectively-assessed course patterns of illness in randomized clinical trial participants.

J Affect Disord, 67 (2001), pp. 123-132

Medline

[5]

F Cassidy, K Forest, E Murry, et al.

A factor analysis of the signs and symptoms of mania.

Arch Gen Psychiatry, 55 (1998), pp. 27-32

Medline

[6]

DW Scott.

Multivariate density estimation: theory, practice, and visualization, Wiley, (1992),

[7]

ML Hamshere, K Gordon-Smith, L Forty, et al.

Age-at-onset in bipolar-I disorder: mixture analysis of 1369 cases identifies three distinct clinical subgroups.

J Affect Disord, 116 (2009), pp. 23-29

http://dx.doi.org/10.1016/j.jad.2008.10.021 | Medline

[8]

F Tozzi, M Manchia, NW Galwey, et al.

Admixture analysis of age at onset in bipolar disorder.

Psychiatry Res, 185 (2011), pp. 27-32

http://dx.doi.org/10.1016/j.psychres.2009.11.025 | Medline

[9]

M Manchia, S Lampus, C Chillotti, et al.

Age at onset in Sardinian bipolar I patients: evidence for three subgroups.

Bipolar Disord, 10 (2008), pp. 443-446

http://dx.doi.org/10.1111/j.1399-5618.2007.00572.x | Medline

[10]

PI Lin, MG McInnis, JB Potash, et al.

Clinical correlates and familial aggregation of age at onset in bipolar disorder.

Am J Psychiatry, 163 (2006), pp. 240-246

http://dx.doi.org/10.1176/appi.ajp.163.2.240 | Medline

[11]

F Bellivier, JL Golmard, M Rietschel, et al.

Age at onset in bipolar I affective disorder: further evidence for three subgroups.

Am J Psychiatry, 160 (2003), pp. 999-1001

http://dx.doi.org/10.1176/appi.ajp.160.5.999 | Medline

[12]

E Mick, J Biederman, SV Faraone, et al.

Defining a developmental subtype of bipolar disorder in a sample of nonreferred adults by age at onset.

J Child Adolesc Psychopharmacol, 13 (2003), pp. 453-462

http://dx.doi.org/10.1089/104454603322724841 | Medline

[13]

MP DelBello, CA Soutullo, W Hendricks, et al.

Prior stimulant treatment in adolescents with bipolar disorder: association with age at onset.

Bipolar Disord, 3 (2001), pp. 53-57

Medline

[14]

N Kennedy, J Boydell, S Kalidindi, et al.

Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England.

Am J Psychiatry, 162 (2005), pp. 257-262

http://dx.doi.org/10.1176/appi.ajp.162.2.257 | Medline

[15]

M Manchia, CC Zai, A Squassina, et al.

Mixture regression analysis on age at onset in bipolar disorder patients: investigation of the role of serotonergic genes.

Eur Neuropsychopharmacol, 20 (2010), pp. 663-670

http://dx.doi.org/10.1016/j.euroneuro.2010.04.001 | Medline

[16]

A Squassina, M Manchia, M Costa, et al.

Age at onset in bipolar disorder: Investigation of the role of TaqIA polymorphism of DRD2 gene in a Sardinian sample.

Eur Psychiatry, 26 (2011), pp. 141-143

http://dx.doi.org/10.1016/j.eurpsy.2010.09.013 | Medline

[17]

F Mathieu, MH Dizier, B Etain, et al.

European collaborative study of early-onset bipolar disorder: Evidence for genetic heterogeneity on 2q14 according to age at onset.

Am J Med Genet B Neuropsychiatr Genet, 153B (2010), pp. 1425-1433

http://dx.doi.org/10.1002/ajmg.b.31121 | Medline

[18]

TV Lagerberg, K Sundet, SR Aminoff, et al.

Excessive cannabis use is associated with earlier age at onset in bipolar disorder.

Eur Arch Psychiatry Clin Neurosci, 261 (2011), pp. 397-405

http://dx.doi.org/10.1007/s00406-011-0188-4 | Medline

[19]

M De Hert, M Wampers, T Jendricko, et al.

Effects of cannabis use on age at onset in schizophrenia and bipolar disorder.

Schizophr Res, 126 (2011), pp. 270-276

http://dx.doi.org/10.1016/j.schres.2010.07.003 | Medline

[20]

PV da Silva Magalhaes, FA Gomes, M Kunz, et al.

Birth-cohort and dual diagnosis effects on age-at-onset in Brazilian patients with bipolar I disorder.

Acta Psychiatr Scand, 120 (2009), pp. 492-495

http://dx.doi.org/10.1111/j.1600-0447.2009.01426.x | Medline

[21]

A Yildiz, GS Sachs.

Age onset of psychotic versus non-psychotic bipolar illness in men and in women.

J Affect Disord, 74 (2003), pp. 197-201

Medline

[22]

TG Schulze, DJ Muller, H Krauss, et al.

Further evidence for age of onset being an indicator for severity in bipolar disorder.

J Affect Disord, 68 (2002), pp. 343-345

Medline

[23]

C Engstrom, S Brandstrom, S Sigvardsson, et al.

Bipolar disorder. II: personality and age of onset.

Bipolar Disord, 5 (2003), pp. 340-348

Medline

[24]

M López-Larson, JL Breeze, DN Kennedy, et al.

Age-related changes in the corpus callosum in early-onset bipolar disorder assessed using volumetric and cross-sectional measurements.

Brain Imaging Behav, 4 (2010), pp. 220-231

http://dx.doi.org/10.1007/s11682-010-9101-4 | Medline

[25]

JF Goldberg, JL Garno.

Age at onset of bipolar disorder and risk for comorbid borderline personality disorder.

Bipolar Disord, 11 (2009), pp. 205-208

http://dx.doi.org/10.1111/j.1399-5618.2008.00653.x | Medline

[26]

BI Goldstein, AJ Levitt.

Further evidence for a developmental subtype of bipolar disorder defined by age at onset: results from the national epidemiologic survey on alcohol and related conditions.

Am J Psychiatry, 163 (2006), pp. 1633-1636

http://dx.doi.org/10.1176/ajp.2006.163.9.1633 | Medline

[27]

I Kawa, JD Carter, PR Joyce, et al.

Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation.

Bipolar Disord, 7 (2005), pp. 119-125

http://dx.doi.org/10.1111/j.1399-5618.2004.00180.x | Medline

[28]

G Masi, G Perugi, S Millepiedi, et al.

Developmental differences according to age at onset in juvenile bipolar disorder.

J Child Adolesc Psychopharmacol, 16 (2006), pp. 679-685

http://dx.doi.org/10.1089/cap.2006.16.679 | Medline

[29]

N Javaid, JL Kennedy, V De Luca.

Ethnicity and Age at Onset in Bipolar Spectrum Disorders.

CNS Spectr, (2011 Jun 1),

[30]

RH Perlis, EB Dennehy, DJ Miklowitz, et al.

Retrospective age at onset of bipolar disorder and outcome during two-year follow-up: results from the STEP-BD study.

Bipolar Disord, 11 (2009), pp. 391-400

http://dx.doi.org/10.1111/j.1399-5618.2009.00686.x | Medline

[31]

F Oostervink, MM Boomsma, WA Nolen, et al.

Bipolar disorder in the elderly; different effects of age and of age of onset.

J Affect Disord, 116 (2009), pp. 176-183

http://dx.doi.org/10.1016/j.jad.2008.11.012 | Medline

[32]

CL Ernst, JF Goldberg.

Clinical features related to age at onset in bipolar disorder.

J Affect Disord, 82 (2004), pp. 21-27

http://dx.doi.org/10.1016/j.jad.2003.10.002 | Medline

[33]

TD Carter, E Mundo, SV Parikh, et al.

Early age at onset as a risk factor for poor outcome of bipolar disorder.

J Psychiatr Res, 37 (2003), pp. 297-303

Medline

[34]

S Meeks.

Bipolar disorder in the latter half of life: symptom presentation, global functioning and age of onset.

J Affect Disord, 52 (1999), pp. 161-167

Medline

[35]

G Morken, AE Vaaler, GE Folden, et al.

Age at onset of first episode and time to treatment in in-patients with bipolar disorder.

Br J Psychiatry, 194 (2009), pp. 559-560

http://dx.doi.org/10.1192/bjp.bp.108.054452 | Medline

[36]

K Suominen, O Mantere, H Valtonen, et al.

Early age at onset of bipolar disorder is associated with more severe clinical features but delayed treatment seeking.

Bipolar Disord, 9 (2007), pp. 698-705

http://dx.doi.org/10.1111/j.1399-5618.2007.00388.x | Medline

[37]

KN Chengappa, DJ Kupfer, E Frank, et al.

Relationship of birth cohort and early age at onset of illness in a bipolar disorder case registry.

Am J Psychiatry, 160 (2003), pp. 1636-1642

http://dx.doi.org/10.1176/appi.ajp.160.9.1636 | Medline

[38]

L Tondo, B Lepri, N Cruz, et al.

Age at onset in 3014 Sardinian bipolar and major depressive disorder patients.

Acta Psychiatr Scand, 121 (2010), pp. 446-452

http://dx.doi.org/10.1111/j.1600-0447.2009.01523.x | Medline

[39]

F Benazzi, HS Akiskal.

How best to identify a bipolar-related subtype among major depressive patients without spontaneous hypomania: superiority of age at onset criterion over recurrence and polarity?.

J Affect Disord, 107 (2008), pp. 77-88

http://dx.doi.org/10.1016/j.jad.2007.07.032 | Medline

[40]

RJ Baldessarini, L Bolzani, N Cruz, et al.

Onset-age of bipolar disorders at six international sites.

J Affect Disord, 121 (2010), pp. 143-146

http://dx.doi.org/10.1016/j.jad.2009.05.030 | Medline

[41]

D Chu, AG Gildengers, PR Houck, et al.

Does age at onset have clinical significance in older adults with bipolar disorder?.

Int J Geriatr Psychiatry, 25 (2010), pp. 1266-1271

http://dx.doi.org/10.1002/gps.2466 | Medline

[42]

CA Depp, H Jin, S Mohamed, et al.

Bipolar disorder in middle-aged and elderly adults: is age of onset important?.

J Nerv Ment Dis, 192 (2004), pp. 796-799

Medline

[43]

OP Almeida, S Fenner.

Bipolar disorder: similarities and differences between patients with illness onset before and after 65 years of age.

Int Psychogeriatr, 14 (2002), pp. 311-322

Medline

[44]

American Psychiatric Association (APA), Task Force on DSM-IV.

Diagnostic and statistical manual of mental disorders: DSM-IV: international version with ICD-10 codes, 4th ed., APA, (1995),

[45]

R Sánchez, L Jaramillo, C Gómez.

Desarrollo y validación de una escala para medir síntomas maníacos: Escala para Manía de la Universidad Nacional de Colombia (EMUN).

Rev Colomb Psiquiatr, 37 (2008), pp. 516-537

[46]

F Leisch.

FlexMix: A general framework for finite mixture models and latent class regression in R. J Statist Software [internet]. 2004. [citado: 1 de febrero de 2012].

Disponible en: http://www.jstatsoft.org/v11/i08/

[47]

G Perugi, C Micheli, HS Akiskal, et al.

Polarity of the first episode, clinical characteristics, and course of manic depressive illness: a systematic retrospective investigation of 320 bipolar I patients.

Compr Psychiatry, 41 (2000), pp. 13-18

Medline

[48]

CG Reichart, J van der Ende, M Wals, et al.

The use of the GBI as predictor of bipolar disorder in a population of adolescent offspring of parents with a bipolar disorder.

J Affect Disord, 89 (2005), pp. 147-155

http://dx.doi.org/10.1016/j.jad.2005.09.007 | Medline

[49]

D Cicero, RS El-Mallakh, J Holman, et al.

Antidepressant exposure in bipolar children.

Psychiatry, 66 (2003), pp. 317-322

Medline