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Fortschr Neurol Psychiatr 2005; 73(6): 343-351
DOI: 10.1055/s-2004-830246
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Bipolare affektive und schizoaffektive Störungen des höheren Lebensalters

Bipolar Affective and Schizoaffective Disorders of Older Age - Classification, Symptoms and CourseP.  Brieger1 , J.  Hensel1 , A.  Marneros1
  • 1Universitätsklinik für Psychiatrie und Psychotherapie, Martin-Luther-Universität Halle-Wittenberg, 06097 Halle/Saale (Direktor: Prof. Dr. med. Dr. h. c. Andreas Marneros)
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Publication History

Publication Date:
25 April 2005 (online)

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Zusammenfassung

Bipolare affektive und schizoaffektive Störungen des höheren Lebensalters werden zu selten diagnostiziert. Dabei wird ihnen absehbar in den nächsten Jahren versorgungspolitisch wachsende Bedeutung zukommen. In dieser Übersichtsarbeit werden Befunde zur Klassifikation, Psychopathologie, Epidemiologie, Verlauf, Prognose, Bildgebung, Familienuntersuchungen und Therapie dargestellt und bewertet. Dabei wird deutlich, dass bipolare (schizo)affektive Störungen des höheren Lebensalters eine diagnostisch heterogene Gruppe sind, insbesondere da die sekundären Manien nosologisch von „endogenen” bipolaren Störungen abzugrenzen sind. Es gibt einige Besonderheiten der bipolaren Störungen des höheren Lebensalters: Geschlechtsverhältnis, Ersterkrankungsalter, Mortalität und Komorbidität mit neurologischen Erkrankungen sind hier besonders zu nennen. In vielen Bereichen unterscheiden sich aber bipolare Störungen des höheren Lebensalters nicht wesentlich von denen jüngerer Patienten. Hinsichtlich der Akut- und Erhaltungstherapie gibt es kaum kontrollierte Studien. Lithium kommt eine große Bedeutung zu, auch wenn der Einsatz anderer Substanzen, von Psychoedukation und Elektrokrampftherapie analog wie in jüngeren Altersgruppen erfolgen kann, wenn Besonderheiten älterer Menschen bedacht werden (z. B. erhöhte Sturzgefahr).

Abstract

Bipolar affective and schizoaffective disorders of older age are underdiagnosed, although they are of growing importance for psychiatric services. In this review article, we present and discuss results concerning classification, psychopathology, epidemiology, course, prognosis, neuroimaging, family studies and therapy. Bipolar (schizo)affective disorders of older age are a diagnostic heterogeneous group, especially as secondary manias must be separated from “endogenous” bipolar disorders nosologically. Bipolar (schizo)affective disorders of older age show some peculiarities: Gender ratio, age at onset, mortality and comorbidity with neurological disease are amongst them. Nevertheless, in many other aspects bipolar (schizo)affective disorders of older age do not differ from bipolar disorders of younger patients. For the acute and maintenance treatment there is a dearth of controlled studies. Lithium is of great importance. Other substances, as well as psychoeducation and ECT may be used analogously as in younger patients, if age specific factors are taken into account (as for example the danger of falls).

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Priv.-Doz. Dr. med. Peter Brieger

Universitätsklinik für Psychiatrie und Psychotherapie

Martin-Luther-Universität Halle-Wittenberg

06097 Halle/Saale

Email: peter.brieger@medizin.uni-halle.de

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