Mania Compared With Unipolar Depression in Old Age

Objective: The goal of this study was to clarify the meaning and importance of mania in old age. Method: The authors conducted a retrospective study ofSO elderly patients consecu-tively admitted to a private mental hospital with an index episode ofmania. As a comparison group, they used 50 age- and sex-matched patients with unipolar depression. They reviewed the charts of the I 00 patients for family history, clinical course, and neurological disorders. Outcome was determined by contacting patients, families, physicians, institutional settings, and vital statistics records. Survival analysis compared mortality rates. Results: The manic patients had a greater familial predisposition to affective disorder and were younger at first psychiatric hospitalization. For the 20 manic patients whose first affective episode was depres-sion, an average of 1 5 years elapsed before mania became manifest. Eighteen of the manic patients, compared with only four of the depressed patients, had neurological disorders. The manic patients had a significantly higher mortality rate than the depressed patients; by the end of the follow-up, 25 of the manic patients, compared with 1 0 of the depressed patients, had died. Conclusions: Mania appears to have a poorer prognosis and to be a more severe form ofaffective illness than unipolar depression. The 1 8 manic patients with neurologi cal disorder