Sustaining Remission of Psychotic Depression: The STOP-PD II Study Treatment Risks and Benefits in Late Life

IntroductionSeveral risk factors make older adults more prone to psychosis. The persistent growth in the elderly population makes important the necessity of accurate diagnosis of psychosis, since this population has special features especially regarding to the pharmacotherapy and side effects.ObjectivesTo review the medical literature related to late-life psychosis.MethodsMedline search and ulterior review of the related literature.ResultsReinhard et al. [1] highlight the fact that up to 60% of patients with late onset psychosis have a secondary psychosis, including: metabolic (electrolite abnormalities, vitamines defficiency…); infections (meningitides, encephalitides…); neurological (dementia, epilepsy…); endocrine (hypoglycemia…); and intoxication. Colijn et al. [2] describe the epidemiological and clinical features of the following disorders: schizophrenia (0.3% lifetime prevalence > 65 years); delusional disorder (0.18% lifetime prevalence); psychotic depression (0.35% lifetime prevalence); schizoaffective disorder (0.32% lifetime prevalence); Alzheimer disease (41.1% prevalence of psychotic symptoms); Parkinson's disease (43% prevalence of psychotic symptoms); Parkinson's disease dementia (89% prevalence of visual hallucinations); Lewy body dementia (up to 78% prevalence of hallucinations) and vascular dementia (variable estimates of psychotic symptoms). Recommendations for treatment include risperidone, olanzapine, quetiapine, aripiprazole, clozapine, donepezil and rivastigmine.ConclusionsDifferential diagnosis is tremendously important in elderly people, as late-life psychosis can be a manifestation of organic disturbances. Mental disorders such as schizophrenia or psychotic depression may have different manifestations in comparison with early onset psychosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Introductory Information for Therapists

Treating Late Life Depression ◽

10.1093/med-psych/9780195383690.003.0001 ◽

2009 ◽

pp. 1-20

Author(s):

Dolores Gallagher-Thompson ◽

Larry W. Thompson

Keyword(s):

Cognitive Behavioral Therapy ◽

Diagnostic Criteria ◽

Treatment Program ◽

Program Implementation ◽

Behavioral Therapy ◽

Late Life ◽

The Elderly ◽

Evidence Base ◽

Cognitive Behavioral ◽

Risks And Benefits

This chapter presents introductory information for therapists on this cognitive-behavioral therapy (CBT) program for depression in late life, including diagnostic criteria for depression, development of this treatment program and evidence base, recommendations for program implementation, the CBT model of depression in the elderly, risks and benefits of the treatment program, alternative treatments, and an online of the treatment program itself.

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Pharmacological treatment for unipolar psychotic depression

The British Journal of Psychiatry ◽

10.1192/bjp.bp.105.010470 ◽

2006 ◽

Vol 188 (5) ◽

pp. 410-415 ◽

Cited By ~ 59

Author(s):

Jaap Wijkstra ◽

Jeroen Lijmer ◽

Ferdi J. Balk ◽

John R. Geddes ◽

Willem A. Nolen

Keyword(s):

Systematic Review ◽

Pharmacological Treatment ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Clinical Effectiveness ◽

Controlled Trials ◽

Psychotic Depression ◽

Pharmacological Treatments ◽

Risks And Benefits ◽

Randomised Controlled

BackgroundThe optimal pharmacological treatment of unipolar psychotic depression is uncertain.AimsTo compare the clinical effectiveness of pharmacological treatments for patients with unipolar psychotic depression.MethodSystematic review and meta-analysis of randomised controlled trials.ResultsTen trials were included in the review. We found no evidence that the combination of an antidepressant with an antipsychotic is more effective than an antidepressant alone. This combination was statistically more effective than an antipsychotic alone.ConclusionsAntidepressant mono-therapy and adding an antipsychotic if the patient does not respond, or starting with the combination of an antidepressant and an antipsychotic, both appear to be appropriate options for patients with unipolar psychotic depression. However, clinically the balance between risks and benefits may suggest the first option should be preferred for many patients. Starting with an antipsychotic alone appears to be inadequate.

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Psychotic Late-Life Depression: A 376-Case Study

International Psychogeriatrics ◽

10.1017/s1041610299005888 ◽

1999 ◽

Vol 11 (3) ◽

pp. 325-332 ◽

Cited By ~ 1

Author(s):

Franco Benazzi

Keyword(s):

Rating Scale ◽

Bipolar Depression ◽

Late Life ◽

Psychotic Depression ◽

Global Assessment Of Functioning ◽

Late Life Depression ◽

Younger Patients ◽

Unipolar Disorder ◽

Age Related ◽

Psychotic Features

The aim of the report was to study clinical differences between psychotic late-life depression and psychotic depression in younger patients, to determine if differences were age-related or specific for psychotic late-life depression. Three hundred seventy-six consecutive outpatients, presenting for treatment of unipolar or bipolar depression (with or without psychotic features), were assessed by means of the Structured Clinical Interview for DSM-IV, the Montgomery and Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. Results showed that psychotic late-life (50 years or more) depression, versus psychotic depression in younger patients, was associated with significantly higher age at study entry/onset, longer duration, and lower comorbidity. Psychotic depression versus nonpsychotic late-life depression, in late-life and in younger patients, was associated with significantly greater severity, lower comorbidity, more patients with bipolar I disorder, and fewer patients with unipolar disorder. Findings were related to psychosis or to age, and not to specific features of psychotic late-life depression. These results support a unitary view of psychotic depression.

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