First-onset functional brief psychoses in the elderly.

BACKGROUND AND PURPOSE: The origin and nosological status of psychotic states first arising in late life remain uncertain. We aimed to evaluate the diagnostic stability of brief psychoses with late-life onset. METHODS: A 10-year retrospective analysis of all records of elderly patients with a first-ever episode of psychosis was undertaken. RESULTS: Of 2,072 admissions of elderly patients, 604 had their first brief psychotic disorder (International Classification of Diseases diagnoses). All "organic" psychoses were excluded. The study sample comprised 83 individuals (36 male, 47 female) with a mean ± SD age of 75.4±9.3 years (range: 65-92). Mean follow-up duration was 27.7 months (range: 6-120). Distribution of diagnoses was as follows: unspecified nonorganic psychosis (n = 71); persistent delusional disorder (n = 10); other nonorganic psychosis (n = 1); and acute and transient psychotic disorder (n = 1). At follow-up, diagnosis of very late-onset schizophrenia-like psychosis and switch to another brief psychotic disorder were the most frequent outcomes. CONCLUSIONS: The diagnosis of a nonorganic psychosis first manifesting in the elderly is not rare in tertiary care. Diagnostic shift at follow-up of these patients is more common than conceptualized, requiring flexibility on the part of treating physicians.

An alternative model for psychiatric service delivery for people with intellectual disabilities in a vocational rehabilitation center.

The prevalence of mental illness in the intellectually disabled (ID) population is high. Because of their special characteristics, such as involvement of multiple carers (family, social services, protected housing staff, vocational instructors), linguistic limitations and the need for a familiar and steady environment, these patients require special therapeutic consideration. In Israel, as in many other countries, people with ID (PWID) receive psychiatric services from general psychiatric outpatient clinics and hospitals; their treatment is generally not specifically tailored to their needs, and hence often suboptimal. In this article we will review some models of psychiatric service delivery for PWID and present an alternative model that we have developed. Our service has been operating since December 1998; it is based upon cooperation between the municipal social services and the local psychiatric outpatient clinic, and is provided in a vocational rehabilitation center where most mild to moderate ID individuals in our area, the city of Bat Yam, are employed. During the first five years (1999-2004) of the operation of the service, 42 people (about half the total number of clients passing through the vocational rehabilitation center during this period) were examined by the psychiatrist; 37 of them (88%) had at least one psychiatric diagnosis. There were especially high rates of adjustment disorder (26% of all principal diagnoses) and of behavior disorder (24% of all principal diagnoses). This model for psychiatric service delivery for PWID in a vocational-rehabilitation center, based as it is on cooperation between the different care agencies, facilitates more accurate psychiatric diagnosis and hence the provision of more appropriate treatment, which in practice usually consists of a combination of pharmacological and behavioral treatment together with educational programs and support for families and staff. Based on our positive experience with this model, we believe that it is the most suitable framework of treatment for adults with dual diagnosis, and that it should be adopted in other areas.

Increased risk of attempted suicide among aging holocaust survivors.

OBJECTIVE: Suicide rates are higher in elderly persons than in those at other phase of the life-cycle. The majority of World War II (WWII) veterans and Holocaust survivors still define their war experiences as being the "most significant stressor" of their lives. Aging of survivors is frequently associated with depression, reactivation of traumatic syndromes, physical disorders, loss, and psychological distress, possibly increasing the risk of suicide. The aim of the present study was to investigate, among a large cohort of elderly Holocaust survivors, whether their WWII experiences confer an increased risk of suicidal behavior. METHODS: All medical records of elderly patients admitted to a psychiatric hospital in Israel during a 5-year period were retrospectively evaluated. Suicidal patients were compared with patients who had not attempted suicide. RESULTS: Of 921 eligible patients, 374 were Holocaust survivors; 135 (14.6%) had attempted suicide in the month before admission. Ninety Holocaust survivors (24%) had attempted suicide, versus 45 of the 502 patients (8.2%) with no WWII experience. The risk of attempted suicide among Holocaust survivors was significantly increased. CONCLUSION: Although these findings are from a highly selected sample, we suggest that aging Holocaust survivors are at increased risk of attempting suicide. The growth of the elderly population, of whom many had had traumatic life experiences, emphasizes the need to implement preventive strategies so that suicidal risk may be contained.