Secondary Mania in Older Adults

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

Information about differences between younger and older patients with bipolar disorder and between older patients with early and late age of onset of illness during long-term treatment is scarce. This study aimed to investigate the differences in treatment and treatment outcome between older and younger manic bipolar patients and between early-onset bipolar (EOB) and late-onset bipolar (LOB) older patients. The European Mania in Bipolar Longitudinal Evaluation of Medication study was a 2-year prospective, observational study in 3459 bipolar patients on the treatment and outcome of patients with an acute manic or mixed episode. Patients were assessed at 6, 12, 18, and 24 months post-baseline. We calculated the number of patients with a remission, recovery, relapse, and recurrence and the mean time to achieve this. Older patients did not differ from younger bipolar patients in achieving remission and recovery or suffering a relapse and in the time to achieve this. However, more older patients recurred and in shorter time. Older patients used less atypical antipsychotics and more antidepressants and other concomitant psychiatric medication. Older EOB and LOB patients did not differ in treatment, but more older LOB patients tended to recover than older EOB patients. Older bipolar manic patients did not differ from younger bipolar patients in short-term treatment outcome (remission and recovery), but in the long term, this may be more difficult to maintain. Distinguishing age groups in bipolar study populations may be useful when considering treatment and treatment outcome and warrants further study.

AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Elderly Patients: Expert Review

Secondary mania associated with enterococcal meningitis in an elderly patient

The aim of this study was to determine clinical and outcome differences between older bipolar patients with early onset (EO) and late onset (LO) of the illness and between younger and EO older patients with a bipolar disorder under long-term treatment in an outpatient clinical setting. Three hundred ninety-five bipolar I and II outpatients were followed up for up to 7.7 years. Of these, 213 younger (<50 years) and 88 older (>60 years) patients were included. In the older subsample, 50 EO patients (onset <50 years) versus 38 LO patients (≥50 years) were analyzed. Likewise, younger versus EO older patients were compared. The likelihood of LO older patients of being bipolar II was higher than for EO older patients. They were also diagnosed earlier than EO older patients. No other clinical differences at baseline and at the prospective follow-up were found. Compared with younger patients, EO older patients had more frequent depressive symptoms at baseline, suffered more major depressive episodes in the previous year and in the prospective follow-up, received more antidepressants at baseline, had higher rates of medical comorbid conditions and were less likely to be tobacco smokers. Older patients constitute a meaningful proportion of bipolar patients under treatment. EO older patients suffered significantly from more frequent depressive symptoms than younger ones. LO older patients were predominantly bipolar II. So as bipolar illness progressed, depressive symptomatology became more frequent and manic episodes were less severe. Copyright © 2016 John Wiley & Sons, Ltd.

Distinct Circulating Genomic Features of Classical Hodgkin Lymphoma of Older Adults

Challenges with the management of older patients with cancer during the COVID-19 pandemic

In the process of studying the toxicity of uric acid from patients with manic–depressive illness in guinea pigs, the Australian physician John Cade noted in 1949 that animals became lethargic after injection with lithium carbonate, a monovalent cation (Cade, 1978). This led to the administration of lithium citrate to a manic adult patient who had a marked clinical improvement (Cade, 1978). Twenty years later, lithium was approved by the Federal Drug Administration (FDA) for the treatment of mania in adults. Since then, it has traditionally been used as the preferred treatment of mania in adults (Post et al., 1997) and adolescents (Strober et al., 1990) with bipolar disorder (BD). One double-blind, placebocontrolled study of adolescent mania showing a 43% response efficacy (Geller et al., 1998a) suggests that adolescents with BD may have a similar or even lower response efficacy to lithium compared with adults.

Impact and Safety of Chimeric Antigen Receptor T Cell Therapy in Vulnerable Older Patients with Relapsed/Refractory Diffuse Large B-Cell Lymphoma

little is known on the clinical implications of vancomycin trough levels among older patients. to evaluate the association between vancomycin levels and outcomes among older versus younger patients. retrospective study. patients aged 18-64 and ≥65years treated with vancomycin for documented methicillin resistant Staphylococcus aureus (MRSA) infections. we compared the effectiveness and toxicity of vancomycin according to trough levels in older versus younger patients. Subgroup analysis of patients with glomerular filtration rate (GFR) > 60ml/min/1.73m2 was performed. we included 181 patients aged ≥65years and 104 younger patients. Mean age in the older group was 76.9 ± 8years versus 50.9 ± 12.4 in the younger group. Vancomycin trough levels and 24-hours area under the curve to minimal inhibitory concentrations (AUC/MIC) were significantly higher in older patients who were also significantly more likely to achieve trough levels of ≥15mg/l within 4days, (98/181 (54.1%) vs. 38/104 (36.5%) in younger patients, P = 0.004). Results were similar among patients with GFR > 60. Thirty-day mortality was significantly higher in older (74/181, 40.9% vs. 13/104, 12.5%, respectively, P < 0.001). There was no association between vancomycin trough levels and mortality among older patients. No significant differences were demonstrated in clinical or microbiological success or nephrotoxicity. applying uniform dosing recommendations across age groups among adults with MRSA infections results in higher vancomycin levels and AUC/MIC in older versus younger patients. Yet, mortality rates remain higher among older adults. Prospective studies are needed to define the optimal approach for using this drug in older patients.

The microwaves of the CMBR behave like stationary waves (or standing waves). They serve as an absolute framework of reference at rest.

Successful Immunologic and Virologic Outcomes in Elderly HIV-Infected Patients

Evaluating Age as a Predictor of Postoperative Opioid Use and Prescribing Habits in Older Adults With Cancer

BackgroundThe evidence on age-related differences in outcomes in patients seeking chiropractic care for low back pain is limited. The aims of this study were to (i) to explore differences in patient characteristics and symptoms between older, middle-aged and younger patients with LBP seeking chiropractic care, (ii) to investigate whether age was associated with changes in physical function at 2, 13 and 52 weeks follow-up and (iii) to evaluate if other specific demographic variables were associated with changes in physical function over time.MethodsThis observational cohort study (November 2016 to December 2018) used data from the Danish Chiropractic Low Back Pain Cohort (ChiCo). Participants ≥ 18 years seeking chiropractic care for new onset low back pain were categorised into three age groups: young adults (< 40 years), middle-aged adults (40–59 years), and older adults (≥ 60 years). Disability was assessed at baseline and at 2, 13 and 52 weeks follow-up using the Roland Morris Disability Questionnaire. Associations between age groups and disability outcomes were analysed using linear regression, while associations with demographics, and social and psychological factors were examined using backward stepwise linear regression.Results2777 participants were included. At baseline, there were no significant differences in disability scores between age groups. Older patients reported more non-musculoskeletal comorbidities and prescription pain medication use, compared to younger and middle-aged patients. Younger patients showed higher depression and anxiety levels compared to middle-aged and older patients. Younger and middle-aged patients more frequently reported multiple musculoskeletal comorbidities than older patients. At all follow-ups, older patients had slightly higher disability scores and showed less improvement over time compared to younger and middle-aged patients, indicating a modest association between age and poorer outcomes. Higher baseline disability, more musculoskeletal comorbidities, worse self-reported health, and higher depression scores were more consistently associated with less improvement in disability over time.ConclusionOlder chiropractic patients with low back pain had slightly higher disability scores compared to younger and middle-aged patients, but age was not the strongest factor associated with disability outcomes. Baseline disability, depression, self-perceived general health, and MSK comorbidities were more consistently linked to higher disability scores across all follow-up time points.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12998-025-00589-w.

Bipolar affective disorder is a serious mental disease associated with significant morbidity and mortality. Good-quality research available to guide treatment strategies remains insufficient, particularly with regard to manic or hypomanic episodes. A critical review of the various stages of mania might be helpful for pharmaceutical companies and investigators as a prerequisite for the clinical evaluation of potential antimanic properties of medications. The main difficulty is with a comparison between anticonvulsants, antipsychotics, and mood stabilizers such as lithium (with equal efficacy in the acute phase and the prevention of recurrent manic episodes). No consensus has been reached with regard to the treatment of bouts of acute mania in various parts of the world. Controlled clinical trials have, at last, provided irrefutable evidence of the activity of lithium, which has long been used alone, as well as that of divalproate or its derivatives and, to a lesser extent, carbamazepine. The new antipsychotic agents have more recently established their efficacy, especially aripiprazole, asenapine, quetiapine; olanzapine, risperidone, and ziprasidone (not sure where the paradox is). In Europe, haloperidol is still the reference substance used in clinical trials despite the fact that it is not officially indicated in the treatment of mania. In the USA, lithium, divalproate, or antipsychotics can be prescribed as first-line treatment. In Europe, lithium remains the first-line medication, whereas divalproate and atypical antipsychotic agents are used only as second-line therapy. Although both types of medication (antipsychotics, normothymic agents, and/or anticonvulsants) have proved to be clinically effective in the management of mania by reducing the mania scores overall, the same does not apply, however, to all symptoms of mania. Factorial approaches to mania have all shown that since there are several clinical forms of mania, several clusters of manic symptoms can be identified. Antipsychotic and normothymic agents and/or anticonvulsants do not appear to have the same effects on each of these identifiable clusters of symptoms, mainly psychotic features. We believe that it is vitally important for future clinical trials of mania treatment to focus on the treatment effect by adopting a factorial approach to characterization of the episode using an appropriate methodological structure. These questions highlight the uncertainty shrouding the very structure of manic episodes, namely that these are predominantly of a thymic or psychotic nature. The Europeans undoubtedly consider mania to be more of a thymic episode and prefer lithium as the first-line treatment, whereas the Americans believe that psychotic symptoms dominate and widely prescribe antipsychotic agents. However, from the standpoint of clinical trials currently available, even though antipsychotic agents are certainly effective in reducing the scores on the mania scales, it is not clear whether they can be considered purely as antimania treatments.