Objective: To test the validity and reliability of the Chinese Geriatric Mental State Schedule (CGMS) in Taiwanese elders. Methods: The CGMS has gone through a standardized two-way translation, a pretest phase, and consensus focus group meetings in order to modify relevant culture-related terms of the original English version. The interrater reliability of the CGMS among eight psychiatrists was conducted after a training course was given to them. Diagnoses generated by the CGMS-AGECAT (Automated Geriatric Examination for Computer Assisted Taxonomy) were compared with psychiatric diagnoses according to the DSM-III-R criteria. The sample subjects were aged 65 and over and recruited from a community (n = 36) and an “old age home” (n = 56). Results: Four of the eight diagnostic categories generated by the CGMS-AGECAT had a generalized kappa value of 1.0, and the figures for the remaining four categories were acceptable: .8 for depressive neurosis, .6 for anxiety disorder, .5 for schizophrenia, and .5 for depressive psychosis (generalized kappa = .5). The overall agreement between the CGMS-AGECAT and independent psychiatric diagnosis (based on the DSM-III-R criteria) was satisfactory. Conclusion: The CGMS has been found to be a crossculturally valid and reliable instrument for use in Taiwan.

Background: Recent reports have suggested that bipolar disorder beginning in late life is strongly associated with organic brain disease whereas early-onset cases are more likely to be associated with a family history of mood disorder. It is not yet clear whether late-onset bipolar disorder is therefore a “phenocopy” of the classic early-onset disorder, sharing symptoms but having a different etiology, or whether people with early- and late-onset bipolar disorder have a common underlying vulnerability that interacts with age-specific triggering factors. Aim: The present study examines the administrative records of patients treated for bipolar disorder, to establish whether differences between early- and late-onset cases might be consistent with their having distinct etiological processes. Methods: We used a file containing administrative data for all patients with a diagnosis of bipolar disorder who were in contact with the health services of Western Australia between 1980 and 1998. For each contact with psychiatric services, the file provided the patient's age, gender, marital status, educational achievement, employment, ethnic origin, postcode of residence, primary and secondary diagnoses, and the duration of the (administrative) episode. Subjects were designated “late-onset” when their first contact with psychiatric services occurred at or after 65 years of age. Results: Between 1980 and 1998 there were 33,004 service contacts involving 6,182 individuals whose primary or secondary clinical diagnosis was bipolar disorder. This indicates that the prevalence of bipolar disorder in Western Australia is approximately 0.4%. Most patients had an onset of illness between 15 and 45 years of age, but 492 patients (8%) were aged 65 years or over at the time of first contact with mental health services. We observed that the relative frequency of late-onset bipolar disorder increased between 1980 and 1998 (1% to 11%). There was an excess of women in our cohort (3:2), but no difference in the age of onset between males and females. Early onset was associated with a subsequently lower socioeconomic status, aboriginal ethnicity, and a higher frequency of mixed affective episodes, other mood disorders, schizophrenia, and schizoaffective disorder. Patients with late-onset bipolar disorder were more likely to have a diagnosis of organic mental disorder recorded (2.8% vs. 1.2%). There was no evidence of a bimodal pattern of age-specific incidence. Conclusion: The observed differences between early- and late-onset bipolar disorders are small and most likely attributable to differences in the duration of illness. Only a small proportion of patients with bipolar disorder were ever diagnosed with an organic mental disorder, which suggests that the reported association between late onset of illness and organic factors may be of limited clinical relevance.

Objective: To examine the demographic, prescription, ingestion, and psychiatric diagnostic factors that distinguished elderly from nonelderly patients treated for deliberate self-poisoning (DSP). Method: A prospective case series study of 2,667 patients presenting to a regional referral center for poisoning (Newcastle Mater Hospital, NSW, Australia), January 1991 to July 1998. The sample was stratified into two groups, 65 years or greater (n = 110) and 64 years or less (n = 2,557) at the time of index admission. The groups were compared using a forward stepwise logistic regression model. Uncontrolled comparisons were analyzed by chi-square statistic with Bonferroni-adjusted p values and controlled comparisons by odds ratio (OR) with 95% confidence interval (CI). Results: The elderly group represented 4.1% of the total. The logistic regression analysis found the elderly DSP group was more likely to have a longer length of stay (OR 5.90, CI 3.87–9.00), to have been prescribed “other” drugs (neither benzodiazepines, mood treatment drugs, nor paracetamol) before admission (OR 5.32, CI 3.34–8.48), to have been prescribed benzodiazepines (OR 3.15, CI 2.03–4.89), and to be diagnosed with major depression (OR 2.17, CI 1.41–3.36) than the younger group. The elderly group was less likely to have ingested paracetamol (OR 0.28, CI 0.14–0.54) or “other” drugs (neither benzodiazepines nor mood treatment drugs) in the DSP episode (OR 0.33, CI 0.20–0.54). Discussion: Elderly DSP patients differ in several important respects from younger patients. They have higher morbidity as a result of the DSP. Major depression plays a more important role. The strong relationship between benzodiazepine prescription and DSP in the elderly raises questions and possible prevention strategies.