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.

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.

A Delphi study of late-onset personality disorders

2019 ◽  
Vol 31 (07) ◽  
pp. 1007-1013 ◽  
Author(s):  
Erlene Rosowsky ◽  
Emily Lodish ◽  
James M. Ellison ◽  
S. P. J. van Alphen
Keyword(s):  
Personality Disorders ◽  
Old Age ◽  
Assisted Living ◽  
Delphi Study ◽  
De Novo ◽  
Late Onset ◽  
Late Life ◽  
The Core ◽  
The Usa ◽  
The Uk

ABSTRACTObjectives:The DSM-5 describes personality disorders (PDs) as emerging in early life and remaining continuous throughout the life-span. Yet case studies and expert opinion support the existence of late-onset PDs. Little is known about PDs in late life, and our instruments for assessing them are not well validated. Thus, the focus of this exploratory Delphi study was the late-onset PD, with special attention to the accuracy of the core criteria for the diagnosis.Design:A Delphi study was designed to assess the presentation of PDs in late life. The Delphi consisted of three successive rounds of inquiry. Between rounds, the participants were provided with a summary of the panel’s responses.Participants:A panel of 21 experts included published authors, researchers, and teachers from the USA, the UK, Australia, France, Belgium, and the Netherlands.Measurements:Researchers designed a survey that included an introduction, a demographic questionnaire, and five questions that varied in presentation and response format.Results:Experts reached consensus that a variant of PD appears de novo in old age. The core features of inflexibility and pervasiveness may not pertain to late-onset PD. There was agreement that frequently occurring life events contribute selectively to the expression of late-onset PD, with the major ones being death of a spouse or partner and transition to a nursing or assisted-living facility.Conclusions:Nearly all participants took the position that PD can present for the first time in old age and be clinically identifiable without having been so identified earlier in life.

Pseudodementia in Schizophrenia and Mania

1988 ◽  
Vol 22 (1) ◽  
pp. 109-114 ◽  
Author(s):  
J. Murray Wright ◽  
Derrick Silove
Keyword(s):  
Cognitive Impairment ◽  
Old Age ◽  
Clinical Utility ◽  
Late Onset ◽  
The Elderly ◽  
Early Stages ◽  
Functional Psychoses

The importance of differentiating depressive pseudodementia from true dementia seems to be well recognized by psychiatrists, yet there seems less recognition that other functional psychoses in the elderly can present with symptoms of cognitive impairment. In this report, we describe two patients - one suffering from late onset schizophrenia and one from a manic illness - who were diagnosed as suffering from dementia in the early stages of their illnesses. We discuss some of the difficulties in making diagnoses in these cases which include an historical tendency for clinicians, including psychiatrists, to assume an organic aetiology for first presentation psychoses in old age. Although the concept of pseudodementia has been criticised in recent years, we conclude that it retains its clinical utility in that it orientates the clinician to the importance of recognizing treatable functional psychoses in the elderly.

Late-life depression

2014 ◽  
Vol 29 (S3) ◽  
pp. 577-577 ◽  
Author(s):  
K. Ritchie
Keyword(s):  
Depressive Symptomatology ◽  
Late Onset ◽  
Late Life ◽  
Later Life ◽  
The Elderly ◽  
Conclusive Evidence ◽  
First Episode ◽  
Hormonal Changes ◽  
Late Life Depression ◽  
Incident Cases

Late-life depression is highly heterogeneous in clinical presentation, and is also commonly resistant to treatment. While some cases are a continuation of the chronic course of illness beginning in early adulthood, a large number of persons will have a first episode of depression in later life following alife-time of relatively good mental health. While incident cases of major depression tend to decrease with age, the number of persons with clinically significant depressive symptomatology rises. À distinction has often been made between early-onset and late-onset depression, however, there is no conclusive evidence to suggest these are distinct clinical entities. On the other hand observations from a fifteen year prospective population study of psychiatric disorder in the elderly (the ESPRIT Study) supports the alternative idea that depression may be divided into sub-types according to postulated aetiology; for example depression with a strong genetic component, related to hormonal changes, the consequence of trauma; the result of cerebrovascular insult. Exposure to these putative causes may be more common at different points in the life span, thus suggesting age-differences. Our research further suggests that even cases of depression appearing for the first time in late-life, may be initially triggered by risk factors occurring decades before. Our findings suggest, for example, that childhood events may lead to changes in the biology of stress management, which continue throughout life, increasing vulnerability to depression and persisting even after effective treatment of symptoms. Together these observations suggest it may be more meaningful to classify depression in the elderly according to probable principle precipitating factors rather than age.

scholarly journals Universal Basic Income as a Way of Redistribution of Experience between Individuals and Groups

2020 ◽  
Vol 63 (3) ◽  
pp. 131-141
Author(s):  
Alexander A. Pisarev
Keyword(s):  
Old Age ◽  
Elderly Care ◽  
The Elderly ◽  
Basic Income ◽  
Gender And Age ◽  
Traditional Societies ◽  
Material Conditions ◽  
Must Experiment ◽  
First Time

This article reviews the possible role of the universal basic income in the transformation of experience in gender and age perspectives. The universal basic income has been particularly hotly debated in recent decades. Regardless of the position, the common tone of the debates is the imperative “we must experiment.” Such a close interest in the universal basic income derives from the fact that it threatens to change the “generic” for humans situation of finiteness of resources and the need to work. Thus, it is able to change the experience of what it means to be human. Since the universal basic income allows to separate labor from income, it is likely that its introduction will return value to the currently stigmatized or devalued types of labor, such as child care, elderly care or domestic work. It creates opportunities for experience redistribution in gender perspective: care and leaving (career break), affective connection, and sensitivity could become the business of both parents, not just mothers. Another experience redistribution is possible in age perspective. Along with automation of labor, population ageing is a universal process that will sooner or later affect all the countries. Alarmist narratives that present this process as a threat and a problem now prevail. They are largely based on outdated ideas about old age and what it means to be old. However, in fact, ageing is the maturation of the population as a whole. With a proper re-evaluation of the meaning and significance of old age, the introduction of the universal basic income could create material conditions for the transfer of experience from the elderly to the younger – for the first time since traditional societies.

scholarly journals Evaluating Differences in Elastic Modulus of Regenerated and Uninjured Mouse Digit Bone through microCT Density-Elasticity Calculation and Nanoindentation Testing

2021 ◽  
Author(s):  
Kevin F Hoffseth ◽  
Emily Busse ◽  
Michelle Lacey ◽  
Mimi C Sammarco
Keyword(s):  
Elastic Modulus ◽  
De Novo ◽  
The Elderly ◽  
Cost Of Care ◽  
Bone Architecture ◽  
Structural Quality ◽  
Small Scale ◽  
Mineral Density ◽  
First Time

Bone is an essential, healing structure in vertebrates that ensures daily function. However, the regenerative capacity of bone declines with age, compromising quality of life in the elderly and increasing cost of care. Here, for the first time, the elasticity of regenerated bone in a mouse digit amputation model is evaluated in order to better investigate biomechanics of skeletal regeneration. Amputation of the distal one third of the digit (third phalangeal element P3) results in de novo regeneration of the digit, where analyzing the structural quality of this regenerated bone is a challenging task due to its small scale and triangular shape. To date, the evaluation of structural quality of the P3 bone has primarily focused on mineral density and bone architecture. This work describes an image-processing based method for assessment of elasticity in the whole P3 bone by using microcomputed tomography-generated mineral density data to calculate spatially discrete elastic modulus values across the entire P3 bone volume. Further, we validate this method through comparison to nanoindentation-measured values for elastic modulus. Application to a set of regenerated and unamputated digits shows that regenerated bone has a lower elastic modulus compared to the uninjured digit, with a similar trend for experimental hardness values. This method will be impactful in predicting and evaluating the regenerative outcomes of potential treatments and heightens the utility of the P3 regenerative model.

scholarly journals Sir Martin Roth. 6 November 1917 — 26 September 2006

2010 ◽  
Vol 56 ◽  
pp. 377-389
Author(s):  
Michael Rutter ◽  
Aaron Klug
Keyword(s):  
Mental Disorders ◽  
Alzheimer Disease ◽  
Psychiatric Disorders ◽  
Old Age ◽  
Social Problem ◽  
The Elderly ◽  
Pathological Process ◽  
Molecular Studies ◽  
Normal Ageing

Martin Roth was distinguished for his major contributions to the understanding and classification of mental disorders in the elderly. These led to a new discipline, psychogeriatrics, as the problems of late life became recognized as constituting a major medical and social problem. His pioneering investigations led to the crucial demonstration of the differences between the dementias and the affective and other mental disorders of old age. The quantitative neuropathological and psychological studies undertaken by Roth and his colleagues established the pathology of Alzheimer disease as indicative of a disease separate from normal ageing and from other psychiatric disorders. These early studies led to collaborative molecular studies that pointed to a possibly causal pathological process.

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.

scholarly journals Age differences in major depression: results from the National Comorbidity Survey Replication (NCS-R)

2009 ◽  
Vol 40 (2) ◽  
pp. 225-237 ◽  
Author(s):  
R. C. Kessler ◽  
H. Birnbaum ◽  
E. Bromet ◽  
I. Hwang ◽  
N. Sampson ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Old Age ◽  
Age Differences ◽  
Late Life ◽  
The Elderly ◽  
National Comorbidity Survey Replication ◽  
National Comorbidity Survey ◽  
Co Morbidity ◽  
Physical Disorders ◽  
Dsm Iv

BackgroundAlthough depression appears to decrease in late life, this could be due to misattribution of depressive symptom to physical disorders that increase in late life.MethodWe studied age differences in major depressive episodes (MDE) in the National Comorbidity Survey Replication, a national survey of the US household population. DSM-IV MDE was defined without organic exclusions or diagnostic hierarchy rules to facilitate analysis of co-morbidity. Physical disorders were assessed with a standard chronic conditions checklist and mental disorders with the WHO Composite International Diagnostic Interview (CIDI) version 3.0.ResultsLifetime and recent DSM-IV/CIDI MDE were significantly less prevalent among respondents aged ⩾65 years than among younger adults. Recent episode severity, but not duration, was also lower among the elderly. Despite prevalence of mental disorders decreasing with age, co-morbidity of hierarchy-free MDE with these disorders was either highest among the elderly or unrelated to age. Co-morbidity of MDE with physical disorders, in comparison, generally decreased with age despite prevalence of co-morbid physical disorders usually increasing. Somewhat more than half of respondents with 12-month MDE received past-year treatment, but the percentage in treatment was lowest and most concentrated in the general medical sector among the elderly.ConclusionsGiven that physical disorders increase with age independent of depression, their lower associations with MDE in old age argue that causal effects of physical disorders on MDE weaken in old age. This result argues against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders.

scholarly journals The contrasting human gut microbiota in early and late life and implications for host health and disease

2021 ◽  
pp. 1-22
Author(s):  
O. Skillington ◽  
S. Mills ◽  
A. Gupta ◽  
E.A. Mayer ◽  
C.I.R. Gill ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Old Age ◽  
Late Life ◽  
The Elderly ◽  
Negative Consequences ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Health And Development ◽  
Health And Disease ◽  
Diet And Lifestyle

The gut microbiota plays a significant role in health and development from birth and continues to affect several processes throughout life and into old age. During both infancy and old age, the trajectory of the gut microbiota changes with contrasting consequences at both stages for the host. The infant gut is unstable, and colonization is influenced by a variety of perinatal and postnatal factors. Many of these factors can contribute to an altered microbiota profile in infancy which can be associated with negative consequences later in life such as allergies, obesity, and neuropsychiatric disorders. The late-life gut microbiota is influenced by physiological changes within the host, illness, diet and lifestyle that impact its composition and functionality. Indeed, reduced microbial diversity, loss of beneficial microorganisms and increased pathobionts are key signatures of the elderly microbiome. Such changes have been associated with degenerative diseases including inflammageing, Alzheimer’s disease, Parkinson’s disease, and increased risk of infection with Clostridioides difficile. Here, we examine early- and late-life factors that contribute to contrasting gut microbiota disturbances and the consequences associated with these disruptions. Finally, we provide compelling evidence of nutritional and probiotic/prebiotic interventions that may help alleviate the effects of gut microbiota changes into old age.

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