SEARCH · PubMed Health

Results for “Psychotic Disorders”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources

PubMed2003

The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary.

OBJECTIVES: A growing number of atypical antipsychotics are available for clinicians to choose from in the treatment of psychotic disorders. However, a number of important questions concerning medication selection, dosing and dose equivalence, and the management of inadequate response, compliance problems, and relapse have not been adequately addressed by clinical trials. To aid clinical decision-making, a consensus survey of expert opinion on the pharmacologic treatment of psychotic disorders was undertaken to address questions not definitively answered in the research literature. METHOD: Based on a literature review, a written survey was developed with 60 questions and 994 options. Approximately half of the options were scored using a modified version of the RAND 9-point scale for rating the appropriateness of medical decisions. For the other options, the experts were asked to write in answers (e.g., average doses) or check a box to indicate their preferred answer. The survey was sent to 50 national experts on the pharmacologic treatment of psychotic disorders, 47 (94%) of whom completed it. In analyzing the responses to items rated on the 9-point scale, consensus on each option was defined as a non random distribution of scores by chi-square "goodness-of-fit"test. We assigned a categorical rank (first line/preferred choice,second line/alternate choice, third line/usually inappropriate) to each option based on the 95% confidence interval around the mean rating. Guideline tables indicating preferred treatment strategies were then developed for key clinical situations. RESULTS: The expert panel reached consensus on 88% of the options rated on the 9-point scale. The experts overwhelmingly endorsed the atypical antipsychotics for the treatment of psychotic disorders. Risperidone was the top choice for first-episode and multi-episode patients, with the other newer atypicals rated first line or high second line depending on the clinical situation. Clozapine and a long-acting injectable atypical (when available)were other high second line options for multi-episode patients. The expert's dosing recommendations agreed closely with the package inserts for the drugs, and their estimates of dose equivalence among the antipsychotics followed a linear pattern. The experts considered 3-6 weeks an adequate antipsychotic trial, but would wait a little longer (4-10 weeks) before making a major change in treatment regimen if there is a partial response. The experts recommended trying to improve response by increasing the dose of atypical and depot antipsychotics before switching to a different agent; there was less agreement about increasing the dose of conventional antipsychotics before switching, probably because of concern about side effects at higher doses. If it is decided to switch because of inadequate response, risperidone was the expert's first choice to switch to, no matter what drug was initially tried. Although there was some disparity in the expert's recommendations concerning how many agents to try before switching to clozapine, the expert's responses suggest that switching to clozapine should be Clozapine was also the antipsychotic of choice for patients with suicidal behavior. When switching oral antipsychotics,the experts considered cross-titration the preferred strategy. When switching to an injectable antipsychotic, the experts stressed the importance of continuing the oral antipsychotic until therapeutic levels of the injectable agent are achieved. The experts considered psychosocial interventions the first choice strategy for partially compliant patients, with pharmacologic interventions the first choice for patients with clear evidence of noncompliance. However, because it can be difficult to distinguish partially compliant from noncompliant patients, the editors recommended combining psychosocial and pharmacologic interventions to improve compliance whenever possible. When patients relapse because of compliance problems or if there is any doubt about compliance, the experts recommended the use of a long-acting injectable antipsychotic and would select an injectable atypical when this option becomes available. The experts would also consider using an injectable atypical antipsychotic (when available) in many clinical situations that do not involve compliance problems. The experts stressed the importance of monitoring for health problems-especially obesity, diabetes, cardiovascular problems,HIV risk behaviors, medical complications of substance abuse, heavy smoking and its effects, hypertension, and amenorrhea-in patients being treated with antipsychotics. Although many patients are prescribed adjunctive treatments,multiple antipsychotics, and combinations of different classes of drugs (e.g., antipsychotics plus mood stabilizers or antidepressants) in an effort to enhance response, the experts gave little support to any of these strategies, with the exception of antidepressants for patients with dysphoria/depression, antidepressants or ECT for patients with suicidal behavior, and mood stabilizers for patients with aggression/violence. When asked about indicators of remission and recovery, the experts considered acute improvement in psychotic symptoms the most important indicator of remission, whereas they considered more sustained improvement in multiple outcome domains (e.g., occupational/educational functioning, peer relationships,independent living) important in assessing recovery. CONCLUSIONS: The experts reached a high level of consensus on many of the key treatment questions in the survey. Within the limits of expert opinion and with the expectation that future research data will take precedence, these guidelines provide direction for addressing common clinical dilemmas that arise in the pharmacologic treatment of psychotic disorders. They can be used to inform clinicians and educate patients regarding the relative merits of a variety of interventions. Clinicians should keep in mind that no guidelines can address the complexities involved in the care of each individual patient and that sound clinical judgment based on clinical experience should be used in applying these recommendations.

Antipsychotic Agents↗

PubMed1989

Psychotic disorders in DSM-III-R.

The authors review the important changes in the three sections of DSM-III-R that include only psychotic disorders (schizophrenia, delusional disorder, and psychotic disorders not elsewhere classified), outline the rationale for these changes, and, where available, review their empirical basis. In addition, they review two proposed changes that were not incorporated into DSM-III-R. They conclude by calling for an increasingly rigorous and data-based process of nosologic revision.

Adult↗

PubMed2005

Differences between early-phase primary psychotic disorders with concurrent substance use and substance-induced psychoses.

CONTEXT: The distinction between a substance-induced psychosis and a primary psychotic disorder that co-occurs with the use of alcohol or other drugs is critical for understanding illness course and planning appropriate treatment, yet there has been little study and evaluation of the differences between these 2 diagnostic groups. OBJECTIVE: To identify key demographic, family, and clinical differences in substance-induced psychosis and primary psychotic disorders diagnosed according to DSM-IV criteria using a research diagnostic instrument for psychiatric and substance use comorbidity. DESIGN: Data on demographic, family, and clinical factors were gathered at baseline as part of a 3-year longitudinal study of early-phase psychosis and substance use comorbidity in New York, NY. SETTING: Psychiatric emergency department admissions. PARTICIPANTS: The study is based on a referred sample of 400 subjects interviewed at baseline. Participants had at least 1 psychotic symptom assessed during administration of the research protocol, had used alcohol and/or other drugs within the past 30 days, and had no psychiatric inpatient history before the past 6 months. Subject race included 43.5% black, 42.0% Hispanic, and 14.5% white or other. MAIN OUTCOME MEASURE: Psychotic disorders defined by the DSM-IV. RESULTS: Overall, 169 (44%) were diagnosed as having substance-induced psychosis and 217 (56%), as having primary psychosis. Significant differences were observed in all 3 domains. Multivariate analysis using logistic regression identified the following 3 key predictors as being greater in the substance-induced group: parental substance abuse (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.00-2.85), a diagnosis of dependence on any drug (OR, 9.41; 95% CI, 5.26-16.85), and visual hallucinations (OR, 2.13; 95% CI, 1.10-4.13). The key predictor of total positive and negative symptom score was greater in the primary psychosis group (OR, 0.96; 95% CI, 0.94-0.97). CONCLUSIONS: Differences in demographic, family, and clinical domains confirm substance-induced and primary psychotic disorders as distinct entities. Key predictors could help emergency clinicians to correctly classify early-phase psychotic disorders that co-occur with substance use.

Adult↗

PubMed2003

Acute and transient psychotic disorders: comparison with schizophrenia.

Concept and nosologic status of acute and transient psychotic disorders, as they appear in the tenth edition of the International Classification of Disease, have seen review from the standpoint of validation and delineation from schizophrenia and affective disorders. Current research, particularly on the epidemiology, course, and outcome, and family genetic studies indicate that these disorders are common among women in developing countries, as well as among lower socioeconomic status and rural subjects. These patients have greater frequency of exposure to stress before childbirth, a family history of acute and transient psychotic disorder (and not of schizophrenia), and a course and outcome that is different from that of schizophrenia. The findings so far support the argument that acute and transient psychotic disorders are different from schizophrenia.

Acute Disease↗

PubMed2002

Mental disorders as possible intrapsychic routes to remission. Part I: delusional and psychotic disorders.

It is hypothesized in this article that delusional and psychotic disorder may be a route to survive and finally to remission when completed successful. The intrapsychic mechanism, or navigation system, that outlines this route takes into account (a) the mental and emotional limitations and vulnerabilities of the patients, and (b) hopelessness of the situation. It was speculated that cognitive and emotional capacities and associated neurobiological dysfunctions that are necessarily linked to delusional/psychotic disorders could be brought about by this intrapsychic mechanism in order to create an escape route which avoids the unbearable reality. When the patient has completed this traject successfully and the circumstances are favourable, the intrapsychic navigation system might restore his or her relevant cognitive and emotional abilities and related neurobiological functions so that the patient is ready for healthy development and remission.

Humans↗

PubMed1999

Interactive risk factors for treatment adherence in a chronic psychotic disorders population.

This study identified the unique and primary contributions of several concurrent risk factors for poor adherence to treatment recommendations in a clinic population of individuals with chronic psychotic disorders, i.e. 48% had DSM-IV diagnoses of schizoaffective disorder, 38% had schizophrenia, paranoid type, 12% had schizophrenia, undifferentiated type, and 2% had affective disorder with psychotic features. The target cohort consisted of 87 consecutive admissions to a continuing day treatment program. As part of a services-oriented quality assurance program, clinical staff completed rating scales for all patients. These included the BASIS-32 rating scale, which consisted of the following five subscales: psychosis; depression/anxiety; impulsive/addictive behavior; relation to self and others; and daily living and role functioning, and the Working Alliance Inventory-short form (therapist version), which consisted of the following three subscales: goal; task; and bond. These data were used to identify risk factors that weaken a patient's adherence to medication and non-medication treatment during the first 2 weeks of treatment in the clinic. Medication treatment consisted of both typical and atypical neuroleptic medications, with most patients being on multiple medications. Correlational analyses suggested that many of the risk factor variables were significantly associated with poor treatment adherence. Regression analyses suggested that the degree of psychoticism was most strongly associated with poor adherence to medication treatment and that difficulties relating to self and others were the strongest predictor of poor adherence to non-medication treatment. A large-sample services research design such as this can begin to determine patterns of associations between previous identified risk factors and poor treatment adherence in individuals with chronic psychotic disorders.

Adult↗

PubMed2003

Features of acute and transient psychotic disorders.

BACKGROUND: Little is known about acute and transient psychotic disorders (ATPD), a diagnostic category introduced with ICD-10. AIMS: To determine the clinical and sociodemographic features, course and outcome of ICD-10 ATPD in a prospective and longitudinal study. METHOD: We recruited all consecutive inpatients fulfilling the ICD-10 criteria of ATPD during a 5-year period. Demographic and clinical features were systematically evaluated and follow-up investigations were carried out at an average of 10 years after onset of the disorder using standardized instruments. RESULTS: ATPD patients represented 8.5% of all inpatients with non-organic psychotic disorders. ATPD were characterized by female preponderance. In two-thirds of the cases a typical polymorphic symptomatology was found. In spite of the fact that the possibility of relapse within 5 years was high, the psychopathological and social outcome for most of the patients was very favourable. Schizophrenic episodes during follow-up were rare (7.7% of patients), but a strictly monomorphous course (ATPD episodes only) from index episode to the end of the prospective follow-up was found in only 53.9% of the patients. CONCLUSION: ATPD are not a sharply demarcated and unchanging nosological entity. Nevertheless, the present data support a delineation of ATPD as a diagnostic category with specific clinical features and with a usually favourable prognosis. Further research on the topic is necessary.

Acute Disease↗

PubMed2000

When acute-stage psychosis and substance use co-occur: differentiating substance-induced and primary psychotic disorders.

Substances such as alcohol, cocaine, amphetamine, and cannabis can produce psychotic reactions in individuals who are otherwise free of serious mental illness. However, persons with primary psychotic disorders, such as schizophrenia and bipolar disorder, who use these substances often present for treatment with signs and symptoms similar to those whose psychosis resulted from the use of drugs alone. While it is often difficult to distinguish substance-induced from primary psychoses, especially early in the course of treatment, this differential diagnosis has important implications for treatment planning. To help clinicians distinguish these two types of presentations, the authors first review the types of psychotic symptoms that can co-occur with substance use. They discuss the prevalence and patterns of substance use that have been found in patients with schizophrenia and other primary psychotic disorders and review the negative outcomes associated with substance use in this population. The prevalence of and types of symptoms and problems associated with psychotic symptoms that occur as a result of substance use alone are also reviewed. The authors describe assessment procedures for differentiating substance-induced and primary psychotic disorders. They stress the importance of accurately establishing the temporal relationship between the substance use and the onset and continuation of psychotic symptoms in making a differential diagnosis, as well as the importance of being familiar with the types of psychological symptoms that can occur with specific substances. The authors review the utility and limitations of a number of diagnostic instruments for assessing patients with co-occurring psychosis and substance use problems, including The Addiction Severity Index, The Michigan Alcohol Screening Test, and diagnostic interviews such as the Schedule for Affective Disorders and Schizophrenia and the Structured Clinical Interview for DSM. They then discuss the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), an instrument that has been developed to address the lack of a diagnostic interview that is suitable for assessing the comorbidity of substance use and psychiatric disorders. The article concludes with a discussion of the importance of an appropriate match between diagnosis and treatment and the current state of our knowledge concerning the most appropriate types of treatment interventions for patients with substance-induced psychosis and those with dual diagnoses.

Journal Article↗

PubMed2006

Cognitive insight and psychotic disorder: the impact of active delusions.

While several studies have determined the Beck Cognitive Insight Scale (BCIS; [Beck, A.T., Baruch, E., Balter, J.M., Steer, R.A., Warman, D.M., 2004. A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophr. Res. 68, 319-329] is a useful measure of cognitive insight, a number of questions have remained unanswered. While individuals with psychotic disorders have been shown to have impaired cognitive insight compared to a psychiatric comparison group, it has remained unclear how the cognitive insight of individuals with psychotic disorders compares to healthy individuals. Further, as previous studies have classified participants based on diagnostic classification, it has remained unknown if individuals with delusions and individuals with psychotic disorders without active delusions score differently on this measure. To examine these questions, we assessed the cognitive insight of healthy individuals and individuals with psychotic disorders, both with and without active delusions. Results indicated that individuals with psychotic disorders had impaired cognitive insight relative to healthy controls (p=.005), though individuals with active delusions and individuals with psychotic disorders without delusions had impairments in different domains. Individuals with delusions were overly confident in their own judgment relative to healthy controls and those without delusions (p=.011), though their self-reflectiveness was the same as normal controls. Individuals without delusions reported low self-reflectiveness relative to healthy controls and individuals with delusions (p=.004), though they were not overconfident in their judgment. These results are discussed in terms of existing research on cognitive insight, decision making, and psychosis.

Adult↗

PubMed1996

Mood-congruent vs. mood-incongruent psychotic symptoms in affective psychotic disorders.

This review of the literature on the importance of congruence of mood to identify nosological sub-categories among the affective disorders showed the limited value of this concept. The reported prevalence rates of affective psychoses with mood-congruent, mood-incongruent and a combination of these symptoms vary widely among the different studies. This categorization seems neither to identify sub-groups with distinct demographic and onset characteristics nor to predict course and outcome. Furthermore, the ambiguity of the guidelines and the different use of this concept in the studies increase the confusion. The only heuristic value of the use of this concept seems to be its prediction of change of diagnosis. The authors suggest eliminating the concept of mood congruence from the categorization of affective disorders and, if not, to state more concise and explicit guidelines for research and clinical use.

Affect↗

PubMed2000

Childhood-onset psychotic disorders: magnetic resonance imaging of volumetric differences in brain structure.

OBJECTIVE: Although childhood-onset schizophrenia is rare, children with brief psychotic symptoms and prominent emotional disturbances commonly present diagnostic and treatment problems. Quantitative anatomic brain magnetic resonance images (MRIs) of a subgroup of children with psychotic disorder not otherwise specified were compared with those of children with childhood-onset schizophrenia and healthy comparison subjects. METHOD: Anatomic MRIs were obtained for 71 patients (44 with childhood-onset schizophrenia and 27 with psychotic disorder not otherwise specified) and 106 healthy volunteers. Most patients had been treated with neuroleptics. Volumetric measurements for the cerebrum, anterior frontal region, lateral ventricles, corpus callosum, caudate, putamen, globus pallidus, and midsagittal thalamic area were obtained. RESULTS: Patients had a smaller total cerebral volume than healthy comparison subjects. Analysis of covariance for total cerebral volume and age found that lateral ventricles were larger in both patient groups than in healthy comparison subjects and that schizophrenia patients had a smaller midsagittal thalamic area than both subjects with psychotic disorder not otherwise specified and healthy comparison subjects. CONCLUSIONS: Pediatric patients with psychotic disorder not otherwise specified showed a pattern of brain volumes similar to those found in childhood-onset schizophrenia. Neither group showed a decrease in volumes of temporal lobe structures. Prospective longitudinal magnetic resonance imaging and clinical follow-up studies of both groups are currently underway to further validate the distinction between these two disorders.

Adolescent↗

PubMed1999

[The development and prognosis of acute psychotic disorders (polymorphic delirium flushes)].

The DSM IV classification of brief psychotic disorders and schizophreniform disorders is unsatisfactory because of its purely temporal criteria for diagnosing acute psychotic disorders, which are seen as a preliminary diagnosis to schizophrenia. We thus decided to use a more inclusive concept, with greater diagnostic possibilities, that of the bouffee delirante polymorphe (BDP) or non-specific delusional episode of Magnan, and then analyze its clinical use. This study examines the use of this diagnosis in a walk-in clinic for patients referred to the ER of a general hospital for acute psychiatric pathology. Over an 18-month period, out of 331 hospitalizations, 91 admissions corresponded to the diagnosis of BDP, with median age of 29 years and a median length of stay of 10 days. The initial diagnosis was of needs only approximate and became more specific with longer length of stay, results of response to therapeutic management, more exact phenomenology of the BDP, more information about the days preceding the episode, and a better knowledge of previous psychiatric episodes. Also useful were the immediate triggering circumstances: intellectual deficit, possible absorption of toxic substances, psychologically traumatic events. The subsequent time course showed the following pathologies in order of decreasing frequency: acute psychotic episodes of schizophrenia, delusional manic episodes, acute paranoid episodes, delusional depressive episodes. Finally, there were bona fide acute psychotic episodes meeting the criteria of BDP, which remained isolated or possibly repetitive and of short duration, partly because of pharmacotherapeutic treatment, but also because of an intrinsically favorable prognosis. Such cases are habitually labeled in the literature reactional psychosis, and should be in our opinion considered separate from schizophrenia.

Acute Disease↗

PubMed2006

Diagnosing psychotic disorders in the emergency department in the context of substance use.

OBJECTIVE: For patients who are actively using a substance and experience psychotic symptoms, determining whether the psychotic symptoms are due to a primary psychotic disorder or are substance induced is challenging, especially in emergency departments, where historical information is limited. This study examined the accuracy and subsequent treatment implications of emergency department diagnoses among substance-using patients who were having their first psychotic episode. METHODS: Emergency department diagnoses for 302 patients were compared with best-estimate longitudinal diagnoses (BELDs) based on research assessments at three time points (baseline, six months, and 12 months). RESULTS: Of the 223 patients whose symptoms were diagnosed in the emergency department as a primary psychotic disorder, one-quarter were determined by the BELD to have substance-induced psychosis or no psychosis. Overall, the diagnostic agreement was only fair (kappa=.32). Patients with an emergency department diagnosis of primary psychosis were significantly more likely than those with an emergency department diagnosis of substance-induced psychosis to be hospitalized, started on antipsychotic medication, and referred to mental health services instead of treatment for substance use (p<.001). Patients given an emergency department diagnosis of primary psychosis who were found by the BELD to have substance-induced psychosis or no psychosis were significantly more likely to be treated for a psychotic disorder rather than for substance-induced psychosis (p<.001) CONCLUSIONS: Clinicians in psychiatric emergency departments appear to have a tendency to attribute psychotic symptoms to a primary psychotic disorder rather than to concurrent substance use. Given that the diagnosis has significant implications for future management, it is important to improve diagnostic approaches in the emergency department.

Adolescent↗

PubMed1996

Predictors of functional outcome among adolescents and young adults with psychotic disorders.

Adolescents and young adults who experience the onset of a psychotic disorder often demonstrate major disruptions in occupational and social functioning. Yet, certain persons appear to be at a greater risk for impaired functioning after an episode of psychosis than others. This review of the psychiatric research literature on outcomes in psychotic disorders identifies several variables predictive of occupational and social functioning among young persons with both affective and nonaffective psychoses. Variables predictive of functional outcomes include diagnosis, symptom severity, duration of onset of symptoms, age of onset of symptoms, gender, stressful life events, premorbid functioning, and social supports. A model for conceptualizing the relationships of these variables to functioning is presented, and the implications for occupational therapy practice and research are discussed.

Adolescent↗

PubMed2001

[The result of testing psychotic disorder patients in general hospital with Minnesota Multiphasic Personality Inventory].

OBJECTIVE: To study the psychological characteristics of patients with psychotic disorder in general hospital. METHODS: 92 male and 158 female patients with psychotic disorder were tested with Minnesota multiphasic personality inventory (MMPI). They consist of 215 cases with neurosis (hypochondriasis, depression, anxiety, obsessive-compulsive disorder, hysteria, neurasthenia); 4 cases with schizoaffective disorder; 3 cases with manic-depressive insanity. 5 cases with schizophrenia and 23 cases of somatoform disease with affective disorder. RESULTS: The scores of F, K, Hs, D, Hy, Pd, Pa, Pt and Si scales in the patients were significantly higher than those in normal controls. The scores of Mf were significantly higher in the male han those in the female patients and the scores of F lower in the male than those in the female patients. CONCLUSIONS: The psychotic disorders as well as seen in patients in general hospital are hypochondriasis and somatoform disorder, and depression of the female.

Adult↗

PubMedDate not supplied

Sensitivity of ICD-10 diagnosis of psychotic disorders in the Israeli National Hospitalization Registry compared with RDC diagnoses based on SADS-L.

OBJECTIVE: The Israeli National Psychiatric Hospitalization Registry is a nationwide list of all psychiatric hospitalizations in the country and has been widely used as a source of data for psychiatric research. This study assessed the sensitivity of the diagnosis of psychotic disorders ( International Statistical Classification of Diseases, 10th Revision [ ICD-10 ] F20.0-F29.9) and schizophrenia ( ICD-10 F20.0-F20.9) in the Registry. METHOD: Registry discharge diagnoses of psychotic disorders ( ICD-10 F20.0-F29.9) and schizophrenia ( ICD-10 F20.0-F20.9) were compared with research diagnoses derived from best-estimate procedures based on Research Diagnostic Criteria (RDC) using structured clinical research interviews, hospital records, and family information. RESULTS: Out of 169 patients meeting RDC for psychotic disorder, 150 also had a diagnosis of psychotic disorders in the Registry, yielding a sensitivity of 0.89. Re-running this analysis for the narrow definition of schizophrenia identified 94 patients who were diagnosed with schizophrenia using RDC; 82 of those patients also had a diagnosis of schizophrenia in the Registry, yielding a sensitivity of 0.87. CONCLUSION: In 87% to 89% of cases with psychotic disorders or with schizophrenia, Registry diagnoses agreed with RDC diagnoses, a rate of agreement comparable with those of other, similar registries. Because a large number of analyses derived from this and similar national registries will be published in the coming years, this constitutes relevant information.

Adult↗

PubMed1999

A case of psychotic disorder associated with a right temporal lesion: a special reference to magnetic resonance imaging and single photon emission computed tomography findings.

A case of psychotic disorder with a right temporal lesion was reported. The patient, a 19 year old male, who underwent a brain surgery to remove the trigeminal Schwannoma, occupying from the right cerebellopontine angle to the right middle cranial fossa. One year postoperatively, he presented with a psychotic disorder, including auditory hallucinations, delusions of persecution and reference, thought hearing, thought insertion and passive experiences. T1-weighted images on magnetic resonance imaging (MRI) demonstrated a low intensity signal area in the right temporal cortex and white matter. T2-weighted images demonstrated a high intensity signal within the same region. Single photon emission computed tomograghy (SPECT) demonstrated a severe low perfusion corresponding to the region in which the MRI demonstrated the abnormalities. The clinical and neuroimaging studies of this case suggest that psychotic disorder may occur in association with a right temporal lesion and MRI and SPECT are useful to evaluate an organic basis for the psychotic disorder.

Adult↗

PubMed1997

The treatment of psychotic disorders in late life.

OBJECTIVE: To review the epidemiology, phenomenology, and treatment of psychotic disorders in late life. METHOD: The literature relating to psychotic symptoms in the elderly is reviewed, with a focus on the following categories: primary psychotic disorders, mood disorders, delirium, Parkinson's disease (PD), and somatic hallucinoses (including Charles Bonnet syndrome [CBS] and musical hallucinosis). Practical clinical treatment implications are discussed. RESULTS: The prevalence of psychotic symptoms increases with age, largely because of underlying medical illnesses such as dementia, delirium, and other neurological disorders that are exacerbated by sensory deficits coupled with social isolation. Treatment with the traditional high-potency neuroleptics is complicated by extrapyramidal symptoms, and sedation, postural hypotension, and anticholinergic effects complicate the use of low-potency traditional agents. Although clozapine may have a narrow use in the treatment-resistant schizophrenia and PD, it is poorly tolerated in the elderly. Risperidone has a wider use in this population and has a favourable clinical profile (at low doses). Other new neuroleptics await more formal evaluation in the elderly. CONCLUSION: Psychotic disorders in old age have more organic associations, which cause greater difficulty in their treatment. Further Evaluation of the use of atypical agents in this elderly group is indicated.

Aged↗