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Yıl:2005; Cilt: 1; Sayı: 29>> Özet
Türkiye Klinikleri Dahili Tıp Bilimleri Dergisi Psikiyatri; 2005;1(29):63-71
Yaşlıda Bipolar Bozukluk
İ İçelli
Psikiyatri AD, Celal Bayar Üniversitesi Tıp Fakültesi, MANİSA
Yaşlının bipolar bozukluğu ile ilgili bilgiler tam değildir ve son çeyrek yüzyılda konu ile ilgili yayınlar yeterli değildir. Mani veya hipomani tanısı yaşlılara konulan hastalık tanılarının %5-10’unu oluşturur. Manik sendromlu yaşlıların çoğunda bipolar duygu durum bozukluğu vardır. Konu ile ilgili yayın azlığı nedeni ile tanı koymak güç olabilir. Manik yaşlıda yönelim bozukluğu, deliryum ve reversibl bilişsel işlev bozukluğu görülebilir. 65 yaş üzeri yaşlıda bipolar bozukluk prevalansı %0.5’tir. Bu oran yaş ilerledikçe daha da düşmektedir. Kadınlarda daha sık rastlanır. Psikotik özelliklerin görülme sıklığı %64 civarındadır. Ailede bipolar öyküsü oranı %39 kadardır. Geç başlangıçlı mani/bipolar bozuklukta yüksek oranda nörolojik hastalığa rastlanır. Yaşlıların yaklaşık %75’inde psikiyatrik, %20’sinde nörolojik komorbidite söz konusudur.Mani tedavisinde lityum ilk seçenektir. Daha sonra da valproat, karbamazepin antimanik olarak sıralanırlar. Bunlara atipik antipsikotikler de eşlik edebilir. Depresif epizotlarda ise spesifik serotonin geri alım inhibitörleri tercih edilmesi gereken gruptur.
Bipolar Disorder In The Elderly
Our knowledge about bipolar disorder in the elderly people is limited and the published studies in the last twenty five [year]s are not satisfactory. Although mania or hypomania constitutes 5% to 10% of the diagnoses of the elderly patients, most patients with manic syndrome have bipolar disorder. Because of the lack of information on this illness, the diagnosis of bipolar disorder in the late life may be difficult. Orientation disorder, delirium and reversible cognitive dysfunction cab be seen during the course of manic state. The prevalence of bipolar disordr in the elderly community over 65 [year]s is 0.5%. The older people with bipolar disorder are more likely to be women. The studies indicate that, this prevalence declines as teh as grows up. The frequency of psychotic features is 64%; the family history estimation in bipolar disorder is 39%. There is a high rate of neurological comorbidity in late-onset of mania/bipolar disorder. Seventy five percent of the elderly people have a psychiatric illness. The rate of the neurological illness is 20%.
Lithium is the first line antimanic agent in the treatment of elderly mania. Divalproate, carbamazepine are also widely used. Atypical antipsychotics have a role in the management of manic states. Selective serotonine reuptake inhibitors are the preferable agents for the treatment of geriatric depression.

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