A Case of Very-late-onset Schizophrenia-like Psychosis

This paper presents the case of a 67-year-old woman who visited the Psychiatry Department complaining of persecutory ideas and auditory hallucinations after a buccal cancer operation. On neuropsychological testing, she demonstrated paranoid psychosis and bizarre thoughts. Hospital admission was recommended for supportive care and treatment with antipsychotics. She was initially treated with olanzapine, but this medication had little effect and was replaced with amisulpride, which reduced the residual symptoms. The aim of this report was to discuss the diagnostic process and treatment of very late-onset schizophrenia-like psychosis.

A study of Late Onset Schizophrenia Clinical Characteristics with Review of Literature.

That schizophrenia does manifest for the first time in old age, has been recognized for a long time. A number of recent epidemiological studies have also documented its onset in old age. It has remained controversial, however, if schizophrenia occurring for the first time in old age is different substantially from schizophrenia manifesting at younger age. A number of efforts have been going on in recent years in different parts of the world to document differences and similarity between two groups on parameters like clinical features, family history, psychopathology, treatment response, and prognosis and outcome. Many studies have appeared on neuroimaging and neurobiology of late onset schizophrenia. Some efforts have also been done in India on this entity. The present study is to examine clinical characteristics of late onset schizophrenia on number of standardized structured instruments. The study compares its results with some well known studies.

Late-life Schizophrenia / 신경정신의학

The author attempted to study on the characteristics of schizophrenia in the elderly by reviewing the literature both on late-onset schizophrenia and early-onset schizophrenia which had extended into middle and old ages. Interest in the elderly schizophrenia has increased greatly overseas since the 1980's. In particular, elderly schizophrenia is different from those of early adulthood in regard of clinical symptoms and response to drug therapy. Therefore, a thorough understanding of the elderly schizophrenia not only helps evaluateing and treating these patients but also leads us to a more comprehensive understanding of the disease. The author reviewed the changes of concepts and etiology, clinical manifestations, prognosis, neurological features, relations to dementia, differential diagnosis with other psychiatric disorders, and drug therapy of late-life schizophrenia. The elderly schizophrenic patients differ from the young schizophrenics in regard of pharmacokinetics and pharmacodynamics. And because the elderly patients are prone to have other medical problems or adverse drug effects, clinicians should be careful in choosing which drug to use and in adjusting its dosage. Especially, due to the high risk of tardive dyskinesia when using classical antipsychotics, the study on atypical antipsychotics such as clozapine and risperidone has increased. Up to now the study on elderly schizophrenia is not sufficient in korea and needs more attention in the future.

Brain MRI Findings for the Patient with the Late Onset Schizophrenia: Comparison among Patients with the Early Onset Schizophrenia, Progressive Schizophrenia, Senile Dementia and Controls

With increasing tendency of incidence and interest for the late onset schzophrenia, concerns about whether this disorder is etiologically or phenomenogically distinctive entity or not have increased also. To clarify the disease entity of the late onset schzophrenia and the role of structural brain changes in its etiology, authors tried to prove following hypothesis : Are there any evidences of structural brain changes in the late-onset schizophrenia? ; If present, are they not different from those of the early-onset schizophrenia or progressive schizophrenia? ; And are they not different from those of senile dementia? Subjects were 6 patients with the late-onset schizophrenia, 6 patients with the early-onset schizophrenia, 6 patients with progressive schizophrenia, 6 patients with Alzheimer's dementia, and 6 controls. We measured regions of interest of the magnetic resonance images by computer assisted planimetry using the AutoCad and digitizer. Our study results may suggest that the third ventricular enlargement and a reversal of normal difference between left and right temporal lobe and left-right difference in posterior lateral ventricle are common brain pathology for all type of schizophrenia including the late onset schzophrenia. And also suggest that brain structural changes of the late onset schizophrenia are related with neurodevelopmental abnormality rather than degenerative change.