Psychosis in the Elderly

Cover......Page 1
Psychosis in the Elderly......Page 4
Contents......Page 6
Contributors......Page 9
Foreword......Page 12
Acknowledgments......Page 14
Introduction......Page 15
Introduction......Page 18
The history of paranoia/paraphrenia......Page 19
Risk factors for old age psychosis......Page 20
The controversy and the attempts to resolve the controversy......Page 21
Epidemiology......Page 22
Conclusions......Page 23
References......Page 24
Early-onset psychotic symptoms......Page 28
Late-onset psychotic symptoms......Page 32
References......Page 37
Part I Late-onset schizophrenia......Page 40
chapter 3 Epidemiology of late-onset schizophrenia......Page 42
Methodological issues......Page 43
Prevalence studies......Page 44
Incidence studies......Page 45
Gender differences......Page 46
Risk factors......Page 47
Conclusions......Page 50
References......Page 51
Introduction......Page 54
Computed tomography......Page 56
Ventricle to brain ratio/ventricular volumes......Page 57
Cortical volume......Page 58
White matter hyperintensities......Page 59
Comparison to early-onset schizophrenia......Page 61
Comparison to other psychiatric disorders......Page 62
Positron emission tomography......Page 63
Single photon-emission computed tomography (SPECT)......Page 64
MRS......Page 66
Conclusions......Page 67
Future directions......Page 68
References......Page 69
chapter 5 The neuropsychology of late-onset schizophrenia......Page 76
The neuropsychology of LOS......Page 77
Comparing the neuropsychological deficits of schizophrenia with early and late onset......Page 78
LOS and cognitive decline......Page 79
Schizophrenia and dementia......Page 80
Conclusion......Page 82
References......Page 83
Part II Management of early- and late-onset schizophrenia......Page 86
Introduction......Page 88
Differences between the old and young—why should there be a specific evidence base?......Page 89
Pharmacokinetic and pharmacodynamic considerations in managing schizophrenia in the elderly......Page 90
Different clinical picture......Page 91
Different etiology......Page 92
What evidence does exist in the elderly?......Page 93
Conclusions......Page 98
References......Page 99
Introduction......Page 102
Disability and handicap......Page 103
Rehabilitation......Page 104
The current concept of psychosocial rehabilitation......Page 105
Psychosocial rehabilitation in old age psychiatry......Page 106
Main strategies in psychosocial rehabilitation for elderly patients suffering from schizophrenia......Page 107
The mental health resources level......Page 108
The societal level......Page 109
References......Page 110
What is multidisciplinary community-based long-term care?......Page 114
Current thinking about community-based services for older people with schizophrenia......Page 115
The application of the multidisciplinary approach in the community......Page 117
Complex choices in therapeutic engagement......Page 121
Complex choices in service delivery......Page 123
Decision making for the manager and team......Page 126
Conclusion......Page 127
References......Page 128
Introduction......Page 130
The staff......Page 132
Medical care......Page 133
Assessments......Page 134
Environment......Page 136
References......Page 137
Introduction......Page 140
Causes of stigma......Page 141
Action against stigma......Page 142
Conclusions......Page 146
References......Page 147
Part III Other psychotic disorders in the elderly......Page 150
Introduction......Page 152
Delirium as a cause of psychosis in the elderly......Page 153
Psychotic symptoms in delirium......Page 154
Inter-relationship between symptoms, subtypes, and etiology......Page 156
Meaning of psychotic symptoms in delirium......Page 157
Differential diagnoses......Page 158
Management......Page 161
Future directions......Page 162
References......Page 163
What is psychotic depression?......Page 166
What causes psychotic depression in late life?......Page 169
Who has psychotic depression?......Page 170
How should we treat psychotic depression in the elderly?......Page 172
What happens to old people with psychotic depression?......Page 174
References......Page 175
Introduction......Page 180
Prevalence, presentation and prognosis......Page 181
Secondary mania and bipolar disorder with central nervous system (CNS) co-morbidity......Page 183
Health resource use......Page 184
Treatment complexities......Page 187
Bipolar mania......Page 188
Bipolar depression......Page 190
Conclusions and future research directions......Page 192
References......Page 193
Classification of psychosis......Page 198
Assessment tools......Page 199
Clinical associations......Page 200
Biological and experimental correlates of psychosis......Page 203
Treatment of psychotic symptoms in dementia......Page 204
References......Page 205
What is stress?......Page 210
PTSD in the elderly......Page 211
Psychotic symptoms and PTSD......Page 212
Chronic PTSD in the elderly......Page 213
Post-psychosis PTSD......Page 215
References......Page 216
Missing the diagnosis can be harmful......Page 218
Alcohol......Page 219
Benzodiazepine withdrawal......Page 220
Differential diagnosis......Page 221
Assessment......Page 222
Relapse prevention in alcohol dependence......Page 223
Summary......Page 224
References......Page 225
Introduction......Page 226
Prevalence and risk factors......Page 228
The role of dopamine in psychotic symptoms in PD......Page 229
The problem of pharmacologically induced excess disability......Page 231
References......Page 233
Classification and epidemiology......Page 236
Anti-parkinsonian drugs......Page 238
Corticosteroids......Page 240
Opiate-related psychoses......Page 242
Cardiovascular drugs......Page 243
Calcium channel blockers......Page 244
Other cardiac drugs......Page 245
Serotonin and neuroleptic malignant syndromes......Page 246
Intensive care unit (ICU) delirium......Page 247
Etiology of iatrogenic psychosis......Page 248
Physiological changes of aging......Page 249
Pharmacodynamic changes of aging......Page 250
Possible pharmacodynamic mechanisms in iatrogenic psychosis......Page 251
References......Page 252
chapter 19 Conclusion: directions for future research and practice......Page 258
References......Page 264
Index......Page 266