Assessing Diagnosis and Symptoms Profiles of Late-Life Psychosis

GeroPsych ◽  
2013 ◽  
Vol 26 (4) ◽  
pp. 205-209 ◽  
Author(s):  
Ali Javadpour ◽  
Maryam Sehatpour ◽  
Arash Mani ◽  
Ali Sahraian
Keyword(s):  
Differential Diagnosis ◽  
Mood Disorders ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Late Life ◽  
Psychotic Symptoms ◽  
Elderly Persons ◽  
Visual Hallucinations ◽  
Symptom Profiles ◽  
Symptom Profile

Background: There are many controversies with regard to the nosology and conditions causing psychosis in old age people. This study defines a symptom profile and differential diagnosis of late-onset psychosis. Method: 201 elderly persons with psychotic symptoms were recruited. All patients were interviewed based on SCID-1 to confirm the possible diagnosis. Results: The most delusional symptom reported by the subjects was persecutory delusion, and visual hallucinations were the most common hallucination. The most repeated diagnosis was dementia, followed by psychosis due to mood disorders, primary psychotic disorders, delirium, and psychosis due to medical conditions. Conclusions: Results from the current study indicate that late-life psychoses form a heterogeneous group of disorders with varying symptom profiles and etiologies.

The Case for a Psychological Perspective on Late-Onset Psychosis

1997 ◽  
Vol 31 (1) ◽  
pp. 68-75 ◽  
Author(s):  
Anne Hassett
Keyword(s):  
Old Age ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Late Life ◽  
Personality Factors ◽  
Elderly Persons ◽  
Developmental Studies ◽  
Vulnerability Factors ◽  
Future Directions ◽  
Self Image

Objective:A conceptual framework is proposed for studying late-onset psychotic disorders. This incorporates developmental and psychological perspectives to complement the biological focus of most recent studies in this area. Method:Studies of late-onset psychosis that focus on the specificity of neuroimaging abnormalities, family history and sensory deficits were reviewed. Aspects of the developmental and personality literature were then examined with the goal of ascertaining their relevance for the emergence of psychosis in late life. Possible future directions incorporating biological and psychological approaches are proposed. Results:The biological abnormalities identified in studies of late-onset psychosis lack the specificity to stand alone as aetiological factors. Neuroimaging changes and sensory impairment are commonly found in study subjects; however, they also occur in elderly persons without psychiatric illness as well as in those with other late-onset psychiatric disorders. Perhaps it is more appropriate to regard these changes as conferring a vulnerability to psychosis in old age, but symptoms do not develop unless other risk factors, either longstanding or ageing-related, are also present. Developmental studies of late life that have used Erikson's concept of a final lifestage crisis of achieving ‘ego-integrity’, suggest that personality style may be influential in determining the negotiation of this last maturational task. Failure to do so results in ‘despair’, fragmentation of self-image and paranoid fears. To date, there has been little investigation of the relevance of these developmental and personality factors for the emergence of psychosis in old age. Conclusions:If we are to advance our understanding of late-onset psychotic disorders, research in this area needs to move beyond the elusive search for specific biological markers. A model of causation that integrates the longitudinal perspective of lifestage tasks with personality and biological vulnerability factors provides a broad framework which protects against premature foreclosure on aetiological determinants.

scholarly journals Catatonia Associated With Late Paraphrenia Successfully Treated With Lithium: A Case Report

2020 ◽  
Author(s):  
Hiroko Sugawara ◽  
Junpei Takamatsu ◽  
Mamoru Hashimoto ◽  
Manabu Ikeda
Keyword(s):  
Case Report ◽  
Mood Disorders ◽  
Electroconvulsive Therapy ◽  
Late Onset ◽  
Treatment Strategies ◽  
Psychotic Symptoms ◽  
Case Presentation ◽  
Limited Efficacy ◽  
Cumulative Evidence ◽  
The Brain

Abstract Background: Catatonia is a psychomotor syndrome that presents various symptoms ranging from stupor to agitation, with prominent disturbances of volition. Its pathogenesis is poorly understood. Benzodiazepines and electroconvulsive therapy (ECT) are safe and effective standard treatments for catatonia; however, alternative treatment strategies have not been established in cases where these treatments are either ineffective or unavailable. Here, we report a case of catatonia associated with late paraphrenia classified as very-late-onset schizophrenia-like psychosis, which was successfully treated with lithium. Case presentation: A 66-year-old single man with hearing impairment developed hallucination and delusions and presented with catatonic stupor after a fall. He initially responded to benzodiazepine therapy; however, his psychotic symptoms became clinically evident and benzodiazepine provided limited efficacy. Blonanserin was ineffective, and ECT was unavailable. His catatonic and psychotic symptoms were finally relieved by lithium monotherapy.Conclusions: Catatonic symptoms are common in patients with mood disorders, suggesting that lithium may be effective in these cases. Moreover, lithium may be effective for both catatonic and psychotic symptoms, as it normalizes imbalances of excitatory and inhibitory systems in the brain, which underlies major psychosis. Cumulative evidence from further cases is needed to validate our findings.

scholarly journals Late-onset psychosis in older outpatients: a retrospective chart review

2014 ◽  
Vol 27 (4) ◽  
pp. 694-696 ◽  
Author(s):  
Teruyuki Matsuoka ◽  
Hiroshi Fujimoto ◽  
Yuka Kato ◽  
Kenji Fukui ◽  
Jin Narumoto
Keyword(s):  
Differential Diagnosis ◽  
Older People ◽  
Mood Disorders ◽  
Clinical Setting ◽  
Chart Review ◽  
Late Onset ◽  
Retrospective Chart Review ◽  
Aged Society

Late-onset psychosis (LOP) has become increasingly prevalent in the clinical setting, especially in the highly aged society, due to the increasing numbers of older people and its disruptive impact on the lives of patients and caregivers. Although previous studies have identified some of the features of LOP (Webster and Grossberg, 1998; Mitford et al., 2010; Tan and Seng, 2012), some of the previous studies did not include patients with dementia and mood disorders. This study addresses the features of LOP in consecutive outpatients to provide information that supports the differential diagnosis.

Treatment of psychoses in the elderly

1996 ◽  
Vol 2 (3) ◽  
pp. 133-139
Author(s):  
A. Phanjoo
Keyword(s):  
Old Age ◽  
Psychotic Disorders ◽  
De Novo ◽  
Late Onset ◽  
Late Life ◽  
The Elderly ◽  
Functional Psychoses ◽  
First Time ◽  
Paranoid Psychosis

Psychotic disorders in the elderly can be divided into three types: disorders that have started in earlier life and persist into old age; disorders that start de novo after the age of 60, and psychoses associated with brain disease, including the dementias. The classification of psychoses in late life has provoked controversy for nearly a century. The debate concerns whether schizophrenia can present at any stage of life or whether functional psychoses, arising for the first time in late life, represent different illnesses. The nomenclature of such disorders consists of numerous terms including late onset schizophrenia, late paraphrenia, paranoid psychosis of late life and schizophreniform psychosis. This plethora of terms has made research difficult to interpret.

Psychosis and dementia: risk factor, prodrome, or cause?

2017 ◽  
Vol 30 (2) ◽  
pp. 209-219 ◽  
Author(s):  
Corinne E. Fischer ◽  
Luis Agüera-Ortiz
Keyword(s):  
Psychotic Disorders ◽  
Clinical Course ◽  
Late Onset ◽  
Early Recognition ◽  
Neuropsychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Functional Psychosis ◽  
Dementia Risk ◽  
Treatment Considerations ◽  
The Impact

ABSTRACTBackground:Progression of dementia is often associated with the emergence of neuropsychiatric symptoms (NPS), though there is recent evidence that NPS may occur in prodromal dementia (PrD) and impact clinical course. Mood and anxiety symptoms are the NPS that tend to occur most frequently in PrD and thus have been most extensively studied. Comparatively, there has been little focus on psychotic symptoms in PrD.Methods:The authors review the existing literature on psychosis in PrD, including the functional psychosis of early and late onset, with a focus on epidemiology, phenomenology, and clinical course and treatment considerations.Results:Patients with psychotic disorders at baseline such as schizophrenia may be more at risk for developing dementia over time, although this is not completely clear. Psychotic symptoms are likely more common in PrD than previously understood based on factor analysis studies, although they are much more common in established dementia. Variability in findings may reflect the heterogeneous nature of PrD studies to date and the lack of inclusion of patients with late onset psychosis in most clinical studies. The presence of psychosis in patients with PrD may be associated with a worse prognosis in terms of mortality and conversion to dementia.Conclusions:Research to date suggests that psychosis in PrD may be more common than previously thought and impact clinical course negatively. Future studies incorporating patients with late onset psychotic disorders, and focusing on the impact of early recognition and treatment, are required to more fully understand the role of psychosis in PrD.

Use of atypical antipsychotic drugs in old age psychiatry

2002 ◽  
Vol 8 (1) ◽  
pp. 49-58 ◽  
Author(s):  
Walter Pierre Bouman ◽  
Gill Pinner
Keyword(s):  
Mood Disorders ◽  
Elderly People ◽  
Old Age ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
Psychotropic Medications ◽  
Psychotic Symptoms ◽  
Organic Psychoses ◽  
Old Age Psychiatry

Antipsychotic drugs are among the most widely prescribed psychotropic medications for elderly people, particularly for the 5–8% of patients who are in institutions. The antipsychotics are indicated for treating psychotic disorders, including schizophrenia, delusional disorder, psychotic symptoms in mood disorders and for a number of organic psychoses.

Late Onset Psychosis. Review

2016 ◽  
Vol 33 (S1) ◽  
pp. S530-S530
Author(s):  
J.M. Hernández Sánchez ◽  
M.Á. Canseco Navarro ◽  
M. Machado Vera ◽  
C. Garay Bravo ◽  
D. Peña Serrano
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Late Onset ◽  
Lewy Body Dementia ◽  
Late Life ◽  
The Elderly ◽  
Lifetime Prevalence ◽  
Psychotic Symptoms ◽  
Psychotic Depression ◽  
Medline Search

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.

Schizophrenia and paranoid disorders in late life

2012 ◽  
pp. 1546-1550
Author(s):  
Barton W. Palmer ◽  
Gauri N. Savla ◽  
Thomas W. Meeks
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Older Adults ◽  
Health Care ◽  
Differential Diagnosis ◽  
Late Life ◽  
Classification Systems ◽  
Health Concern ◽  
Psychotic Symptoms ◽  
Important Public Health

Estimates of the point-prevalence of paranoia and other psychotic symptoms among persons age ⋚ 65 years have ranged from approximately 4 per cent to 6 per cent, and may be as high as 10 per cent among those age ⋚ 85 years. Although the majority of these symptoms occur as secondary psychoses in the context of Alzheimer’s disease or related dementias, the population of people with schizophrenia is ageing along with the general ‘greying’ of the industrialized world, and mental health care for older adults with schizophrenia is expected to be an increasingly important public health concern. This chapter covers clinical features, classification systems, diagnosis and differential diagnosis, epidemiology, aetiology, course and prognosis, treatment, and management.

Electroconvulsive therapy (ECT) treatments in late-onset schizophrenia: Report of a case

2016 ◽  
Vol 33 (S1) ◽  
pp. S556-S556
Author(s):  
M. Valverde Barea ◽  
F. Cartas Moreno ◽  
M.E. Ortigosa Luque
Keyword(s):  
Behavioral Disorders ◽  
Electroconvulsive Therapy ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Personal History ◽  
Psychotic Symptoms ◽  
Sexual Content ◽  
History Of ◽  
Competing Interest ◽  
Effective Result

Female patient, 66 years old, who goes to the doctor because of behavioral disorders and delusional injury 8 months of evolution. She showed no personal history of psychiatric disorders. In the psychopathological examination some relevant symptoms are seen delusions of prejudice with their immediate surroundings, self-referential regarding neighbors and walls. Delusional interpretations of sexual content. Punitive pseudo hallucinations hearing which are identifies with her daughters and sex with her son-in-law. Behavioral disorders consisting of going out naked into the street overnight and rebuking pedestrians; furthermore, she showed heteroaggressivity towards objects. Logical psychotropic treatment is initiated as indicated by the guidelines having no effect. Electroconvulsive therapy being tested an effective result. The late-onset schizophrenia symptoms should be taken into account in people with psychotic symptoms start at an advanced age, but is most prevalent at younger ages. Electroconvulsive therapy (ECT) may be used as an adjunct to drug therapy or as second-line treatment in patients with affective or psychotic disorders resistant to treatment with psychotropic drugs. It is essential a differential diagnosis with dementia symptoms previously established, given that part of the late-onset schizophrenia evolves to dementia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Acute psychotic disorders induced by topiramate: report of two cases

2002 ◽  
Vol 60 (2A) ◽  
pp. 285-287 ◽  
Author(s):  
Florindo Stella ◽  
Dorgival Caetano ◽  
Fernando Cendes ◽  
Carlos A.M. Guerreiro
Keyword(s):  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
The Other ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Visual Hallucinations ◽  
Psychomotor Agitation ◽  
Full Remission ◽  
Epileptic Patients ◽  
Severe Anxiety

We report on two epileptic patients who developed acute psychosis after the use of topiramate (TPM). One patient exhibited severe psychomotor agitation, heteroaggressiveness, auditory and visual hallucinations as well as severe paranoid and mystic delusions. The other patient had psychomotor agitation, depersonalization, derealization, severe anxiety and deluded that he was losing his memory. Both patients had to be taken to the casualty room. After interruption of TPM in one patient and reduction of dose in the other, a full remission of the psychotic symptoms was obtained without the need of antipsychotic drugs. Clinicians should be aware of the possibility of development of acute psychotic symptoms in patients undergoing TPM treatment.

Sign in / Sign up

Export Citation Format

Share Document