Mohammed T. Abou-Saleh

NATURAL HISTORY OF PSYCHIATRIC DISORDERS 101mostly EOS patients, who make up the majority of geriatricschizophrenics. LOS, on the other hand, portends generally pooroutcomes, although social adaptation may be better in this group,compared to EOS 50,58,59 .CONCLUSIONOverall, there is growing evidence that older patients with lateonsetpsychiatric disease are different from those who come to latelife with a history of early-onset psychiatric illness. Their varyingco-morbidity and symptom profiles suggest different (althoughpotentially interacting) etiological factors, with genetic and/orsocial environmental factors predominating in early-onset diseaseand behavioral factors in later onset. More work is needed todescribe any differential course, but social adaptation appearsbetter for elders whose disease experience has been shorter.REFERENCES1. Weissman MM, Bruce ML, Leaf PJ et al. Affective disorders. InRobins LN, Regier DA (eds), Psychiatric Disorders in America: TheEpidemiologic Catchment Area Study. New York: Free Press.2. Ernst C, Angst J. Depression in old age: is there a real decrease inprevalence? A review. Eur Arch Psychiat Clin Neurosci 1995; 245:272–87.3. Blazer DG, Koenig HG. Mood disorders. In Busse EW, Blazer DG,(eds), The American Psychiatric Press Textbook of GeriatricPsychiatry. Washington, DC: American Psychiatric Press, 1996,235–63.4. Katona CLE. Depression in Old Age. Chichester: Wiley, 1994.5. Ohayon MM, Priest RG, Guilleminault C, Caulet M. The prevalenceof depressive disorders in the United Kingdom. Biol Psychiat, 1999;45: 300–7.6. Phillips JC, Henderson AS. The prevalence of depression amongAustralian nursing home residents: results using draft ICD-10 andDSM-III-R criteria. Psychol Med 1991; 21: 739–48.7. Parmelee PA, Katz IR, Lawton MP. Incidence of depression in longtermcare settings. J Gerontol 1992; 47: M189–96.8. Koenig HG, George LK, Peterson BL, Pieper CF. Depression inmedically ill hospitalized older adults: prevalence, characteristics, andcourse of symptoms according to six diagnostic schemes. Am JPsychiat 1997; 154: 1376–83.9. Iliffe S, Tai SS, Haines A et al. Assessment of elderly people in generalpractice. 4. Depression, functional ability and contact with services.Br J Gen Pract 1993; 43: 371–4.10. Evans S, Katona C. Epidemiology of depressive symptoms in elderlyprimary care attenders. Dementia 1993; 4: 327–33.11. Van Ojen R, Hooijer C, Jonker C et al. Late-life depressive disorderin the community, early onset and the decrease of vulnerability withincreasing age. J Affect Dis 1995; 33: 159–66.12. Ball C, Philpot M. Affective disorders. In Ames D, Chiu E (eds),Neuroimaging and the Psychiatry of Late Life, Cambridge: CambridgeUniversity Press, 1997, 172–89.13. Lavretsky H, Lesser IM, Wohl M, Miller BL. Relationship of age, ageat onset, and sex to depression in older adults. Am J Geriat Psychiat1998; 6: 248–56.14. Kuman A, Jin Z, Bilker W, Udupa J, Gottlieb G. Late onset minorand major depression: Early evidence for common neuroanatomicalsubstrates detected by using MRI. Proc Natl Acad Sci USA 1998; 95:7654–8.15. Soares JC, Mann JJ. The anatomy of mood disorders: review ofstructural neuroimaging studies. Biol Psychiat 1997; 41: 86–106.16. Krishnan KRR, Hays JC, Blazer DG. MRI-defined vasculardepression. Am J Psychiat 1997; 154: 497–501.17. Alexopoulos GS, Meyers BS, Young RC et al. ‘Vascular depression’hypothesis. Arch Gen Psychiat 1997; 54: 915–22.18. Krishnan KRR, Tupler LA, Ritchie JC et al. Apolipoprotein E–4frequency in geriatric depression. Biol Psychiat 1996; 40: 69–71.19. Holmes C, Russ C, Kirov G et al. Apolipoprotein E: depressiveillness, depressive symptoms, and Alzheimer’s Disease. Biol Psychiat1998; 43: 159–64.20. Papassotiropoulos A, Bgli M, Jessen F et al. Early-onset and lateonsetdepression are independent of the genetic polymorphism ofapolipoprotein E. Dementia Geriat Cogn Dis 1999; 10: 258–61.21. Baldwin RC, Tomenson B. Depression in later life: a comparison ofsymptoms and risk factors in early and late onset cases. Br J Psychiat1995; 167: 649–52.22. Reynolds CF, Dew MA, Frank E et al. Effects of age at onset of firstlifetime episode of recurrent major depression on treatment responseand illness course in elderly patients. Am J Psychiat 1998; 155: 795–9.23. Lyness JM, Conwell Y, King DA et al. Age of onset and medicalillness in older depressed inpatients. Int Psychogeriat 1995; 7: 63–73.24. Holroyd S, Duryee JJ. Differences in geriatric psychiatry outpatientswith early vs. late-onset depression. Int J Geriat Psychiat 1997; 12:1100–6.25. Krishnan KRR, Hays JC, Tupler LA et al. Clinical andphenomenological comparisons of late-onset and early-onsetdepression. Am J Psychiat 1995; 152: 785–8.26. Beats B. The biological origin of depression in later life. Int J GeriatPsychiat 1996; 11: 349–54.27. Salloway S, Malloy P, Kohn R et al. MRI and neuropsychologicaldifferences in early- and late-life-onset geriatric depression. Neurology1996; 46: 1567–4.28. Cole MG. The prognosis of depression in the elderly. Can Med AssocJ 1990; 143: 336–9.29. Cole MG. Major depression in old age: outcome studies. In ShulmanKI, Tohen M, Kutcher SP (eds), Mood Disorders Across the LifeSpan. New York: Wiley–Liss, 1996, 361–76.30. Dew MA, Reynolds CF III, Houck PR et al. Temporal profiles of thecourse of depression during treatment: predictors of pathways towardrecovery in the elderly. Arch Gen Psychiat 1997; 54: 1016–24.31. Simpson SW, Jackson A, Baldwin RC, Burns A. Subcorticalhyperintensities in late-life depression: acute response to treatmentand neuropsychological impairment. Int Psychogeriat 1997; 9:257–75.32. Wulsin LR, Vaillant GE, Wells VE. A systematic review of themortality of depression. Psychosomat Med 1999; 61: 6–17.33. Rabins PV, Harvis K, Koven S. High fatality rates of late-lifedepression associated with cardiovascular disease. J Affect Dis 1985;9: 165–7.34. Philibert RA, Richards L, Lynch CF, Winokur G. The effect ofgender and age at onset of depression on mortality. J Clin Psychiat1997; 58: 355–60.35. Yassa R, Nair NPV, Iskandar H. Late-onset bipolar disorder.Psychiat Clin N Am 1988; 11(1): 117–31.36. Spicer CC, Hare EH, Slater E. Neurotic and psychotic forms ofdepressive illness: evidence from age-incidence in a national sample.Br J Psychiat 1973; 123: 535–41.37. Eagles JM, Whalley LJ. Ageing and affective disorders: the age at firstonset of affective disorders in Scotland, 1969–1978. Br J Psychiat1985; 147: 180–7.38. Kraepelin E. Manic Depressive Insanity and Paranoia (trans).Edinburgh: Livingstone, 1921.39. Hays JC, Krishnan KRR, George LK, Blazer DG. Age of first onsetof bipolar disorder: demographic, family history, and psychosocialcorrelates. Depression Anxiety 1998; 7: 76–82.40. Steffens DC, Krishnan KRR. Structural neuroimaging and mooddisorders: recent findings, implications for classification, and futuredirections. Biol Psychiat 1998; 43: 705–12.41. Wylie ME, Mulsant BH, Pollock BG et al. Age at onset in geriatricbipolar disorder: effects on clinical presentation and treatmentoutcomes in an inpatient sample. Am J Geriat Psychiat 1999; 7(1):77–83.42. Post F. The management and nature of depressive illnesses in late life:a follow-through study. Br J Psychiat 1972; 121: 393–404.43. Chen ST, Altshuler LL, Spar JE. Bipolar disorder in late life: areview. J Geriat Psychiat Neurol 1998; 11: 29–35.44. Leboyer M, Bellivier F, McKeon P et al. Age at onset and genderresemblance in bipolar siblings. Psychiat Res 1998; 81: 125–31.45. Meeks S. Bipolar disorder in the latter half of life: Symptompresentation, global functioning, and age of onset. J Affect Dis 1999;52: 161–7.