LATE ONSET PSYCHOSIS – A CASE REPORT

Authors

DOI:

https://doi.org/10.21776/ub.jppbr.2024.005.01.2

Abstract

Introduction – Late-onset psychosis is a disorder that is well-known but poorly understood, and it has emerged as an increasingly significant issue in geriatric patients. There is no clear information about whether this psychosis occurs for the first time at this age. Despite being underdiagnosed, this late-onset psychosis responds well to treatment. A bizarre, persecutory delusion is a hallmark symptom of late-onset schizophrenia.

Methods – Presented the case of a 67-year-old woman who visited the Emergency Psychiatry Department complaining of persecutory thoughts, auditory hallucinations, and mild cognitive impairment.

Results – This case report explores the diagnostic process and treatment options for very late-onset schizophrenia-like psychosis, including non-pharmacological and pharmacological approaches.

Discuss – Psychotic symptoms can be caused by a variety of general medical conditions in elderly patients. It is necessary to rule out delirium, dementia, substance-related disorders, delusional disorder, and dissociative disorder before diagnosing Late-onset psychosis. A late-onset psychosis is not only challenging to diagnose but also to treat. Non-pharmacological treatments are the first option in managing late-life psychosis. It includes psycho-education for patients and their families, as well as cognitive behavior therapy (CBT). It is important to monitor for adverse reactions while administering medication, and the lowest dosage should be used to achieve short-term efficacy. In addition to antipsychotic medication, anticholinesterase inhibitors may also be effective in treating these patients.

Conclusion: A careful observation and approach are required to make an etiological diagnosis of late-onset psychosis since there are no pathognomonic signs or symptoms. To achieve the best results, their efficacy and side effects should be monitored with regularity.

 Keywords: late-onset psychosis, dementia, schizophrenia.

References

Pearlson GD, Kreger L, Rabins PV, et al. A chart review study of late-onset and early-onset schizophrenia. Am J Psychiatry. 1989;146(12):1568–1574. https://doi.org/10.1176/ajp.146.12.1568.

Huber G, Gross G, Schüttler R. Spätschizophrenie. Arch. Psychiat. Nervenkr. 1975;221; 53–66. https://doi.org/10.1007/BF00350195.

Talaslahti T, Alanen HM, Hakko H, et al. Patients with very-late-onset schizophrenia-like psychosis have higher mortality rates than elderly patients with earlier onset schizophrenia. Int J Geriatr Psychiatry. 2015; 30(5): 453–459. https://doi.org/10.1002/gps.4159.

Howard R, Rabins PV, Seeman MV, et al. Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. The International Late-Onset Schizophrenia Group. Am J Psychiatry. 2000;157(2):172-178. https://doi.org/10.1176/appi.ajp.157.2.172.

Riecher-Rössler A, Häfner H, Häfner-Ranabauer W, et al. Late-onset schizophrenia versus paranoid psychoses: a valid diagnostic distinction? Am J Geriatr Psychiatry. 2003;11(6):595-604. https://doi.org/10.1176/appi.ajgp.11.6.595.

Howard R, Castle DJ, O’Brien J, et al. Permeable walls, floors, ceilings and doors: partition delusions in late paraphrenia. Int J Geriatr Psychiatry.1992;7:719-724. https://doi.org/10.1002/gps.1476.

Brunelle S, Cole MG, Elie M. Risk factors for the late-onset psychoses: a systematic review of cohort studies. Int J Geriatr Psychiatry.2012; 27(3): 240–252. https://doi.org/10.1002/gps.2702.

Jeste DV, Symonds LL, Harris MJ, et al. Nondementia nonpraecox dementia praecox? Late-onset schizophrenia. Am J Geriatr Psychiatry. 1997;5(4):302–317. https://doi.org/10.1097/00019442-199700540-00005.

Chen L, Selvendra A, Stewart A, et al. Risk factors in early and late onset schizophrenia. Compr. Psychiatry. 2018, 80,155–162. https://doi.org/10.1016/j.comppsych.2017.09.009.

Barta PE, Powers RE, Aylward EH, et al. Quantitative MRI volume changes in late onset schizophrenia and Alzheimer’s disease compared to normal controls. Psychiatry Res. 1997, 68(2-3), 65–75. https://doi.org/10.1016/s0925-4927(96)02751-5.

Prestia A, Boccardi M, Galluzzi S, et al. Hippocampal and amygdalar volume changes in elderly patients with Alzheimer’s disease and schizophrenia. Psychiatry Res. 2011; 192(2):77-83. https://doi.org/10.1016/j.pscychresns.2010.12.015.

Pfammatter M, Junghan UM, Brenner HD. Efficacy of psychological therapy in schizophrenia: Conclusions from metaanalyses. Schizophr. Bull. 2006, 32 (Suppl. 1), S64-S80. https://doi.org/10.1093/schbul/sbl030.

Kern RS, Glynn SM, Horan WP, et al. Psychosocial treatments to promote functional recovery in schizophrenia. Schizophr. Bull. 2009;35(2):347-61. https://doi.org/10.1093/schbul/sbn177.

Howard R, Reeves S. Psychosis and schizophrenia-like disorders in the elderly. J Nutr Health Aging. 2003;7(6):410-411. https://pubmed.ncbi.nlm.nih.gov/14625620/

Targum SD. Treating psychotic symptoms in elderly patients. Prim Care Companion J Clin Psychiatry. 2001; 3(4):156-163. https://doi.org/10.4088/pcc.v03n0402.

Coljin MA, Nitta BH, Grossberg GT. Psychosis in later life: A review and update. Harv Rev Psychiatry. 2015; 23(5):354-67. https://doi.org/10.1097/HRP.0000000000000068.

Mazeh D, Zemishlani C, Aizenberg D, et alY. Patients with very-late-onset schizophrenia-like psychosis: a follow up study. Am J Geriatr Psychiatry. 2005; 13(5):417-9. https://doi.org/10.1176/appi.ajgp.13.5.417.

Downloads

Published

2024-03-31

How to Cite

Siddiqui, J. A., Qureshi, S. F., Metwally, H. H., & Eldaous, A. M. (2024). LATE ONSET PSYCHOSIS – A CASE REPORT. Journal of Psychiatry Psychology and Behavioral Research, 5(1), 7–11. https://doi.org/10.21776/ub.jppbr.2024.005.01.2