The goals of this study were to investigate the prevalence and initial symptoms of the late-onset schizophrenia (LOS: >40 years) and very-late-onset schizophrenia-like psychosis (VLOSLP: >60 years) nosological groups proposed by the International Late-Onset Schizophrenia Group.
This was a retrospective, cross-sectional, chart review study.
The study was conducted at Centre Hospitalier Robert-Giffard (CHRG), Quebec City, Canada.
The medical records of inpatients from the CHRG who presented with psychotic symptoms were analyzed.
Positive and negative symptoms were scored using the SAPS and SANS. Groups' symptoms were compared using chi(2), Fisher's exact tests, t tests, and exact Mann-Whitney tests. An exact conditional logistic regression analysis was performed to determine which clinical characteristics were the most predictive of the groups' classification.
Among the 1,767 unique, first-admission medical records reviewed, 23 (1.3%) inpatients developed their first psychotic symptoms at the age of 40-59 years old (LOS), and 13 (0.7%) at the age of 60 years and above (VLOSLP). LOS patients were more apathetic and presented more abnormal psychomotor activity than the VLOSLP. Persecutory delusions, auditory hallucinations, inappropriate social behavior, formal thought disorders and anhedonia were frequent in the two groups. A logistic regression model including psychomotor abnormalities was statistically relevant to predict the belonging to LOS group.
LOS and VLOSLP are rare. Abnormal psychomotor activity can properly differentiate VLOSLP and LOS. The nosological model proposed by the International Late-Onset Schizophrenia Group is at least partially supported by the present data.
The prevalence of delusional depression, its symptoms and signs, and social and health status of delusional depressives were studied in a Finnish population aged 60 years or over. The prevalence was six per 1,000 men, 12 per 1,000 women, and 10 per 1,000 for both sexes. The overall symptomatology of delusional depressives was more severe than that of nondelusional major depressives or of all nondelusional depressives. The mean age at the onset of depression and the mean duration of depression did not differ between delusional and nondelusional major depressives. Although delusional depressed elderly did not significantly differ statistically from nondelusional major depressives in social status, somatic health status, functional capacity, or occurrence of social or health stress factors; they tended to have a better somatic health status and they tended to be more lonely. The small number of delusional depressives does not give us the opportunity to draw straightforward conclusions about whether elderly delusional depressives are a subcategory differing from other elderly major depressives.
The proposed revision of the ICD-10 category of 'acute and transient psychotic disorders' (ATPDs), subsuming polymorphic, schizophrenic or predominantly delusional syndromes, would restrict their classification to acute polymorphic psychotic disorder, reminiscent of the clinical concepts of bouffée délirante and cycloid psychosis.
We selected all subjects aged 15-64 years (n = 5,426) who were listed in the Danish Psychiatric Central Register with a first-admission diagnosis of ATPDs in 1995-2008 and estimated incidence rates, course and outcome up to 2010.
Although about half of ATPD patients tended to experience transition to another category over a mean follow-up period of 9.3 years, acute polymorphic psychotic disorder fared better in terms of cases with a single episode of psychosis and temporal stability than the subtypes featuring schizophrenic or predominantly delusional symptoms. Acute polymorphic psychotic disorder was more common in females, while cases with acute schizophrenic features predominated in younger males and evolved more often into schizophrenia and related disorders.
These findings suggest that acute polymorphic psychotic disorder exhibits distinctive features and challenge the current approach to the classification of ATPDs.
It is not currently known how psychotic symptoms are associated with the nature of violence among homicide offenders with schizophrenia, or, more specifically, whether different psychotic symptoms are differentially linked with excessive violence.
To identify factors associated with the use of excessive violence among homicide offenders with schizophrenia.
Forensic psychiatric examination statements and Criminal Index File data of 125 consecutive Finnish homicide offenders with a diagnosis of schizophrenia were analysed.
Nearly one-third of the cases in this sample involved extreme violence, including features such as sadism, mutilation, sexual components or multiple stabbings. Excessive violence was a feature of acts when the offender was not the sole perpetrator or when there was a previous homicidal history. Positive psychotic symptoms, including delusions, were not associated with the use of excessive violence.
These results highlight the importance of variables other than clinical state when examining qualitative aspects of homicidal acts, such as the degree and nature of violence, by offenders with schizophrenia. Further study is needed with a more specific focus on the qualities of the violence among different subgroups of offenders, but inclusive of those with psychosis.
AIM: To investigate the frequency of the Schneiderian First Rank Symptoms (FRSs) in a representative group of patients with first-episode schizophrenia and to analyse the predictive value of these symptoms in relation to psychopathology, work situation, depression, dependency and admission after 2 years of treatment. METHOD: 547 patients were included in the Danish OPUS trial. A subgroup of these, namely the 388 patients who fulfilled the diagnostic criteria for schizophrenia (ICD-10), was included in this study. Data from SCAN interviews were used to describe the frequency of the different first rank symptoms and to compare the characteristics of the patients with and without FRSs. RESULTS: FRSs were very common among these patients with first-episode schizophrenia. Only 16% reported no FRSs at all. Almost half of the patients had experienced commenting or discussing voices, and more than 40% had experienced loud thoughts. More patients with than without FRSs had some kind of substance abuse. FRSs at baseline did not predict the level of scores in the psychotic, negative or disorganized dimension after 2 years. Having FRSs at baseline was related to a significantly lower number of days of admission during the two-year period, but was not associated with antipsychotic medication or depression after 2 years. CONCLUSION: FRSs are very common among first-episode psychosis patients, but their predictive value seems to be limited with respect to outcome measures like psychopathology, work or substance abuse. However, FRSs did predict a lower mean of days of admission.
Camden and Islington Mental Health and Social Care Trust, Department of Mental Health Sciences, University College London, Archway Campus, Holborn Union Building, Highgate Hill, London, United Kingdom.
The objective of this study was to determine crossnationally the prevalence of indicators of elder abuse and their relationship to putative risk factors, particularly depression, dementia, and lack of service provision.
Nearly 4,000 people aged 65+ receiving health or social community services in 11 European countries were interviewed using the minimum dataset homecare (MDS-HC) interview, which includes an abuse screen used previously in elder abuse studies and questions about demographic, physical, psychiatric, cognitive, and service factors.
One hundred seventy-nine (4.6%) people assessed had at least one indicator of abuse. The proportion screening positive increased with severity of cognitive impairment, presence of depression, delusions, pressure ulcers, actively resisting care, less informal care, expressed conflict with family or friends, or living in Italy or Germany, but not with having a known psychiatric diagnosis.
Severity of cognitive impairment, depression, and delusions predicted screening positive for abuse in older adults, but having a known psychiatric diagnosis did not, indicating that screening for psychiatric morbidity might be rational strategies to combat elder abuse. People in Italy and Germany were most likely to screen positive for indicators of abuse, and the authors suggest that this might relate to higher levels of dependency in the participants looked after at home in these countries as a result of cultural and service provision differences.
There is limited research on factors that may predict missed appointments. This study examined correlates to missed appointments in a sample of persons attending an outpatient schizophrenia program.
We measured the rate of missed appointments for 342 outpatients with severe and persistent mental illness (that is, with diagnoses of schizophrenia, schizoaffective disorder, and delusional disorder) attending a psychiatric outpatient clinic over a period of 2 years and 3 months. We collected and analyzed demographic and clinical variables to ascertain differences between patients with high and low rates of nonattendance.
Patients who missed 20% or more of their appointments were significantly younger, were more likely to abuse drugs and alcohol, and manifested lower levels of community functioning.
This profile may be useful in helping clinicians to schedule appointments for this clinical population, to identify those who may need community outreach services, and to improve their treatment prospects.
Of 288 patients admitted to our psychogeriatric unit during a 4-year study, seven patients were diagnosed as having symptoms of paranoid schizophrenia (2.4% of all admissions). All the patients were women. Their symptoms included bizarre delusions and auditory hallucinations. Negative symptoms were rare. Attempts to reduce the dosage of neuroleptic medication led to reappearance of the symptoms in six patients and readmission of the seventh.
Sahlgrenska Academy at Göteborg University, Institute of Neuroscience and Physiology, Psychiatry, and Neurochemistry Section, Sahlgrenska University Hospital, Göteborg, Sweden. firstname.lastname@example.org
OBJECTIVE: To examine the 1-year prevalence of psychotic symptoms and schizophrenia in nondemented 95-year-olds, and to examine the relation between psychotic symptoms and other psychiatric symptoms, sensory impairments, and cognitive functioning. PARTICIPANTS: The representative sample was 95-year-olds living in Göteborg, Sweden (N = 338). Individuals with dementia were excluded (N = 175), leaving 163 subjects for this study. DESIGN: This was a cross-sectional population study, including psychiatric and physical examinations, cognitive tests, and interviews with close informants. MEASUREMENTS: Diagnosis of schizophrenia, psychotic symptoms, paranoid ideation and dementia according to Diagnostic and Statistical Manual of Mental Disorders, Third Revision (DSM-III) were measured. Cognitive function was tested with the Mini-Mental State Exam. Other psychiatric symptoms were measured by the Comprehensive Psychopathological Rating Scale. RESULTS: The one-year prevalence of any psychotic symptom was 7.4% (95% confidence interval [CI] 3.8-12.5); including hallucinations 6.7% (95% CI 3.4-11.8) and delusions 0.6% (95% CI 0.0-3.4). Four (2.4%) individuals fulfilled DSM-III-R criteria for schizophrenia. Individuals with psychotic symptoms or paranoid ideation did not differ regarding cognitive functioning compared with individuals without these symptoms. Individuals with hallucinations and paranoid ideation had an increased frequency of previous paranoid personality traits compared with individuals without psychotic symptoms and paranoid ideation. No individuals with psychotic symptoms had a formal thought disorder, incoherence of speech, or flat affect. CONCLUSION: The authors found a high prevalence of psychotic symptoms, paranoid ideation, and schizophrenia in the very old. Most of the symptoms were elucidated by information from key informants, illustrating the importance of including relatives in the evaluation of elderly persons.