PSYCHOSIS IN THE ELDERLY; ED. BY ANNE HASSETT... ET AL

Across the spectrum of psychopathology in later life, psychotic symptomatology has been the most neglected, and although literature in this area is increasing, this is the first book to address the need for an overarching framework to examine and understand late-life psychotic phenomena. Exploring the practical and ethical issues that arise when managing psychotic elderly patients in the community, as well as the sequelae of stigmatisation and carer stress, this text- brings together the latest research findings on schizophrenia as it presents in later life - covers the frequent comorbidity of psychotic symptoms with cognitive impairment, mood disturbance and physical illness - highlights the diversity of late-life psychotic symptomatology, discussing both aetiological considerations and management strategies Cover......Page 1 Psychosis in the Elderly......Page 4 Contents......Page 6 Contributors......Page 9 Foreword......Page 12 Acknowledgments......Page 14 Introduction......Page 15 Introduction......Page 18 The history of paranoia/paraphrenia......Page 19 Risk factors for old age psychosis......Page 20 The controversy and the attempts to resolve the controversy......Page 21 Epidemiology......Page 22 Conclusions......Page 23 References......Page 24 Early-onset psychotic symptoms......Page 28 Late-onset psychotic symptoms......Page 32 References......Page 37 Part I Late-onset schizophrenia......Page 40 chapter 3 Epidemiology of late-onset schizophrenia......Page 42 Methodological issues......Page 43 Prevalence studies......Page 44 Incidence studies......Page 45 Gender differences......Page 46 Risk factors......Page 47 Conclusions......Page 50 References......Page 51 Introduction......Page 54 Computed tomography......Page 56 Ventricle to brain ratio/ventricular volumes......Page 57 Cortical volume......Page 58 White matter hyperintensities......Page 59 Comparison to early-onset schizophrenia......Page 61 Comparison to other psychiatric disorders......Page 62 Positron emission tomography......Page 63 Single photon-emission computed tomography (SPECT)......Page 64 MRS......Page 66 Conclusions......Page 67 Future directions......Page 68 References......Page 69 chapter 5 The neuropsychology of late-onset schizophrenia......Page 76 The neuropsychology of LOS......Page 77 Comparing the neuropsychological deficits of schizophrenia with early and late onset......Page 78 LOS and cognitive decline......Page 79 Schizophrenia and dementia......Page 80 Conclusion......Page 82 References......Page 83 Part II Management of early- and late-onset schizophrenia......Page 86 Introduction......Page 88 Differences between the old and young—why should there be a specific evidence base?......Page 89 Pharmacokinetic and pharmacodynamic considerations in managing schizophrenia in the elderly......Page 90 Different clinical picture......Page 91 Different etiology......Page 92 What evidence does exist in the elderly?......Page 93 Conclusions......Page 98 References......Page 99 Introduction......Page 102 Disability and handicap......Page 103 Rehabilitation......Page 104 The current concept of psychosocial rehabilitation......Page 105 Psychosocial rehabilitation in old age psychiatry......Page 106 Main strategies in psychosocial rehabilitation for elderly patients suffering from schizophrenia......Page 107 The mental health resources level......Page 108 The societal level......Page 109 References......Page 110 What is multidisciplinary community-based long-term care?......Page 114 Current thinking about community-based services for older people with schizophrenia......Page 115 The application of the multidisciplinary approach in the community......Page 117 Complex choices in therapeutic engagement......Page 121 Complex choices in service delivery......Page 123 Decision making for the manager and team......Page 126 Conclusion......Page 127 References......Page 128 Introduction......Page 130 The staff......Page 132 Medical care......Page 133 Assessments......Page 134 Environment......Page 136 References......Page 137 Introduction......Page 140 Causes of stigma......Page 141 Action against stigma......Page 142 Conclusions......Page 146 References......Page 147 Part III Other psychotic disorders in the elderly......Page 150 Introduction......Page 152 Delirium as a cause of psychosis in the elderly......Page 153 Psychotic symptoms in delirium......Page 154 Inter-relationship between symptoms, subtypes, and etiology......Page 156 Meaning of psychotic symptoms in delirium......Page 157 Differential diagnoses......Page 158 Management......Page 161 Future directions......Page 162 References......Page 163 What is psychotic depression?......Page 166 What causes psychotic depression in late life?......Page 169 Who has psychotic depression?......Page 170 How should we treat psychotic depression in the elderly?......Page 172 What happens to old people with psychotic depression?......Page 174 References......Page 175 Introduction......Page 180 Prevalence, presentation and prognosis......Page 181 Secondary mania and bipolar disorder with central nervous system (CNS) co-morbidity......Page 183 Health resource use......Page 184 Treatment complexities......Page 187 Bipolar mania......Page 188 Bipolar depression......Page 190 Conclusions and future research directions......Page 192 References......Page 193 Classification of psychosis......Page 198 Assessment tools......Page 199 Clinical associations......Page 200 Biological and experimental correlates of psychosis......Page 203 Treatment of psychotic symptoms in dementia......Page 204 References......Page 205 What is stress?......Page 210 PTSD in the elderly......Page 211 Psychotic symptoms and PTSD......Page 212 Chronic PTSD in the elderly......Page 213 Post-psychosis PTSD......Page 215 References......Page 216 Missing the diagnosis can be harmful......Page 218 Alcohol......Page 219 Benzodiazepine withdrawal......Page 220 Differential diagnosis......Page 221 Assessment......Page 222 Relapse prevention in alcohol dependence......Page 223 Summary......Page 224 References......Page 225 Introduction......Page 226 Prevalence and risk factors......Page 228 The role of dopamine in psychotic symptoms in PD......Page 229 The problem of pharmacologically induced excess disability......Page 231 References......Page 233 Classification and epidemiology......Page 236 Anti-parkinsonian drugs......Page 238 Corticosteroids......Page 240 Opiate-related psychoses......Page 242 Cardiovascular drugs......Page 243 Calcium channel blockers......Page 244 Other cardiac drugs......Page 245 Serotonin and neuroleptic malignant syndromes......Page 246 Intensive care unit (ICU) delirium......Page 247 Etiology of iatrogenic psychosis......Page 248 Physiological changes of aging......Page 249 Pharmacodynamic changes of aging......Page 250 Possible pharmacodynamic mechanisms in iatrogenic psychosis......Page 251 References......Page 252 chapter 19 Conclusion: directions for future research and practice......Page 258 References......Page 264 Index......Page 266 [Forlagets beskrivelse] 'Psychosis in the Elderly' addresses the practical and ethical issues that arise when managing psychotic elderly patients in the community, as well as the sequelae of stigmatization and carer stress