Late-onset psychosis with somatic delusions.

The authors studied 10 patients who had late-onset psychosis with somatic delusions and 2 comparison groups similar in age and education: 9 late-onset psychosis patients without somatic delusions and 10 normal control subjects. Demographic, clinical, and neuropsychological data were obtained. Brain magnetic resonance imaging was also done and compared. The patients with somatic delusions were somewhat more likely to be women, have been ill longer, and meet DSM-III-R criteria for delusional disorder, compared with late-onset psychotic patients without somatic delusions. Patients with somatic delusions also had lower scores on a full-scale IQ test, compared with the normal comparison subjects. The patients with somatic delusions rarely benefitted from and poorly complied with treatment with psychotropics. The study's limitations, such as small sample size and heterogeneity of diagnosis, as well as the possible clinical implications of these findings are also discussed.

Late life schizophrenia and its treatment: pharmacologic issues in older schizophrenic patients.

Schizophrenia in late life includes both chronic early-onset schizophrenia and late-onset schizophrenia. Treatment with neuroleptics in relatively low doses is often useful in controlling psychotic symptoms in these patients. The value of neuroleptics is limited, however, by the risks of side effects such as tardive dyskinesia.

High incidence of tardive dyskinesia in older outpatients on low doses of neuroleptics.

We are conducting a prospective study of tardive dyskinesia (TD) in psychiatric patients over age 45, a large proportion of whom have had less than 1 month of total lifetime neuroleptic exposure. Patients are treated with the lowest effective dose of either haloperidol (usually 1-3 mg daily) or thioridazine (usually 25-75 mg daily). Patients are reexamined 1 month and 3 months after initial assessment and then at 3-month intervals. To date, a total of 68 patients (mean age 69.5 years) have been evaluated. Survival analysis showed a 27 percent cumulative incidence of TD (the 95% confidence interval being 14% to 40%) with 6 months of neuroleptic treatment in the study. The TD and non-TD patients did not differ on demographic and baseline clinical measures. Instrumental assessment showed that a greater proportion of TD patients had subclinical evidence of dyskinesia prior to the institution of neuroleptics, compared with non-TD patients.

Behavioral problems associated with dementia: diagnosis and treatment.

The more common behavioral disturbances associated with dementia in elderly patients include depression, psychosis, and agitation. Diagnosis of the underlying cause of these behavioral disturbances begins with a careful investigation of possible medical or toxic disturbances, followed by a careful diagnostic assessment for co-morbid psychiatric syndromes. Treatment of the psychiatric syndromes is often beneficial to the demented patient, improving functional status and reducing the potential for additional morbidity. Patients receiving psychoactive drugs require close monitoring for side effects.

Tardive dyskinesia: managing a common neuroleptic side effect.

Neuroleptics are useful medications for the treatment of psychosis and severe behavioral disturbances in the elderly. Unfortunately, older patients are at a high risk of developing deleterious side effects from these medications, especially persistent tardive dyskinesia (TD). Diagnosis, risk factors, and cause and treatment of TD are discussed. It is important to do a careful assessment as to the indications for neuroleptic use, monitor closely for the development of TD and other side effects, and work closely with the patient and family in making decisions about neuroleptic use.