조기발병 및 후기발병 조증의 비교연구

A Comparative Study of Early- and Late-Onset Mania

The authors hypothesized that late-onset menia(beginning after the age 50 regardless of depression history) w ould have clinical and biological differences, compared with early-onset mania(begining before the age 25). A mong 215 patients given the diagnosis of bipolar disorder by D SM - III-R criteria, the psychiatric records of 19 late-onset and 69 early-onset manic patients were compared. The results were as follows ； 1) There were more married, professional, patients with below middle school level of education in the late-onset group. In the early-onset group, more patients were high school graduates and single. 2) The frequency of medical and neurologic diseases was higher in late-onset group, im plicating organic bases of late-onset group. 3) As a mode of initial onset, mania and depression appeared equally in late-onset group and mania was the common form of first onset in early-onset group. 4) W ith the late-onset manic patients whose first episode was depression, an average of 5 years elapsed before mania become manifest. On average there were 1.2 times of depression episode during that latent period. There were no differences in manic symptoms. 5) Duration of the first in-patient treatment for mania was shorter in late-onset group by 16 dayson average. 6 ) Periodic gap between manic episodes was shorter in late-onset group and suggested poor prognosis. In conclusion, although there were some differences in clinical features and courses, due to the lack of biologic markers, it was deficient to prove the biological heterogeneity. Further prospective studies including brain-imaging and neuro-endocrine studies will be required to verify the heterogeneity of mania.