Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-27T11:05:32.734Z Has data issue: false hasContentIssue false
  • English
  • Français

Atypical (second generation) antipsychotic treatment response in very late-onset schizophrenia-like psychosis

Published online by Cambridge University Press:  01 December 2010

Jamie Scott ,
Blaine S. Greenwald ,
Elisse Kramer  and
Mitchell Shuwall
Jamie Scott*
Affiliation:
Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, New York, U.S.A.
Blaine S. Greenwald
Affiliation:
Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, New York, U.S.A.
Elisse Kramer
Affiliation:
Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, New York, U.S.A.
Mitchell Shuwall
Affiliation:
Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, New York, U.S.A.
*
Correspondence should be addressed to: Jamie Scott, Zucker Hillside Hospital, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY 11004, U.S.A. Phone: +1 718 470-8140; Fax: +1 718 470-9784. Email: jscott2@nshs.edu.
Get access

Abstract

Introduction: Symptom amelioration in older patients with very late onset schizophrenia-like psychosis (VLOSLP) is often difficult, with limited psychotropic response reports yielding variable findings. Information about atypical (second generation) antipsychotic use in this population is scant.

Methods: A consecutive sample of geriatric psychiatry outpatients and inpatients with psychotic disorders were retrospectively identified over a 31-month period based on systematic information abstraction from an electronic medical record (e-record). After exclusion criteria were applied, 8/138 outpatients and 13/362 inpatients met inclusion criteria for VLOSLP and had been naturalistically treated with an atypical antipsychotic during hospitalization or nine months of outpatient care. Mandatorily completed e-record standardized symptom severity response ratings were converted into positive treatment response thresholds.

Results: 38% of outpatients and 77% of inpatients (mean age = 76 years for both groups; mean age of onset of psychosis = 70 years for outpatients and 74 years for inpatients) met criteria for positive treatment response to an atypical antipsychotic (either aripiprazole, olanzapine, quetiapine, or risperidone) with sign/symptom amelioration, rather than eradication.

Conclusions: Various atypical antipsychotics at geriatric doses yielded a positive treatment response in nearly two-thirds of VLOSLP patients. Patients with less chronic, more severe symptoms responded at a higher rate. Prospective, double-blind, placebo-controlled trials with representative subject samples are needed to validate these preliminary findings.

Keywords

atypicalantipsychoticschizophrenialate-onsetpsychosis
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 5 , June 2011 , pp. 742 - 748
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alici-Evcimen, Y., Ertan, T. and Eker, E. (2003). Case series with late-onset psychosis hospitalized in a geriatric psychiatry unit in Turkey: experience in 9 years. International Psychogeriatrics, 15, 69–72.Google Scholar
Almeida, O., Howard, R., Levy, R. and David, A. (1995). Psychotic states arising in late life (late paraphrenia): psychopathology and nosology. British Journal of Psychiatry, 166, 205–214.CrossRefGoogle ScholarPubMed
Arunpongpaisal, S., Ahmed, I., Aqeel, N. and Paholpak, S. (2003). Antipsychotic drug treatment for elderly people with late-onset schizophrenia. Cochrane Database Systems Review, 2, CD004162.Google Scholar
Barak, Y., Aizenberg, D., Mirecki, I., Mazeh, D. and Achiron, A. (2002). Very late-onset schizophrenia-like psychosis: clinical and imaging characteristics in comparison with elderly patients with schizophrenia. Journal of Nervous and Mental Disease, 190, 733–736.Google Scholar
Förstl, H., Howard, R., Almeida, O. P. and Stadtmuller, G. (1992). Psychotic symptoms and the paraphrenic brain. In Katona, C. and Levy, R. (eds.), Delusions and Hallucinations in Old Age. London: Gaskell (Royal College of Psychiatrists).Google Scholar
Girard, C. and Simard, M. (2008). Clinical characterization of late- and very late-onset first psychotic episode in psychiatric inpatients. American Journal of Geriatric Psychiatry, 16, 478–487.Google Scholar
Howard, R. and Reeves, S. (2003). Psychosis and schizophrenia-like disorders in the elderly. Journal of Nutrition, Health and Aging, 7, 410–411.Google Scholar
Howard, R., Cluckie, A. and Levy, R. (1993). Striatal-D2receptor binding in late paraphrenia [Letter]. Lancet, 342, 562.Google Scholar
Howard, R., Almeida, O. P. and Levy, R. (1994). Phenomenology, demography and diagnosis in late paraphrenia. Psychological Medicine, 24, 397–410.Google Scholar
Howard, R. J. et al. (1997). A controlled family study of late-onset non-affective psychosis (late paraphrenia). British Journal of Psychiatry, 170, 511–514.Google Scholar
Howard, R., Rabins, P. V, Seeman, M. V. and Jeste, D. V. (2000). Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. American Journal of Psychiatry, 157, 172–178.CrossRefGoogle ScholarPubMed
Jeste, D. V., Rockwell, E., Harris, M. J., Lohr, J. B. and Lacro, J. (1999a). Conventional versus newer antipsychotics in elderly patients. American Journal of Geriatric Psychiatry, 7, 70–76.Google Scholar
Jeste, D. V., Lacro, J. P., Bailey, A., Rockwell, E., Harris, M. J. and Caligiuri, M. P. (1999b). Lower incidence of tardive dyskinesia with risperidone compared with haloperidol in older patients. Journal of the American Geriatric Society, 47, 716–719.Google Scholar
Jones, D. K. et al. (2005). A diffusion tensor magnetic resonance imaging study of frontal cortex connections in very-late-onset schizophrenia-like psychosis. American Journal of Geriatric Psychiatry, 13, 1092–1099.Google Scholar
Kay, D. W. K. and Roth, M. (1961). Environmental and hereditary factors in the schizophrenias of old age (“late paraphrenia”) and their bearing on the general problem of causation in schizophrenia. Journal of Mental Science, 107, 649–686.Google Scholar
Marneros, A., Deister, A. and Rohde, A. (1992). Schizophrenia, schizoaffective and affective disorders in the elderly: a comparison. In: Katona, C. and Levy, R. (eds.), Delusions and Hallucinations in Old Age (pp. 136–152). London: Gaskell, Royal College of Psychiatrists.Google Scholar
Mazeh, D., Zemishiani, C., Aizenberg, D. and Barak, Y. (2005). Patients with very-late-onset schizophrenia-like psychosis: a follow-up study. American Journal of Geriatric Psychiatry, 13, 417–419.Google Scholar
Moore, R. et al. (2006). Misunderstanding the intentions of others: an exploratory study of the cognitive etiology of persecutory delusions in very late-onset schizophrenia-like psychosis. American Journal of Geriatric Psychiatry, 14, 410–418.Google Scholar
Palmer, B. W., McClure, F. S. and Jeste, D. V. (2001). Schizophrenia in late life: findings challenge traditional concepts. Harvard Review of Psychiatry, 9, 51–58.Google Scholar
Pearlson, G. D. et al. (1989). A chart review study of late-onset and early-onset schizophrenia. American Journal of Psychiatry, 146, 1568–1574.Google Scholar
Pearlson, G. D. et al. (1993). Quantitative D2 receptor PET and structural MRI changes in late-onset schizophrenia. Schizophrenia Bulletin, 19, 783–795.Google Scholar
Post, F. (1966). Persistent Persecutory States. Oxford: Pergamon Press.Google Scholar
Reeves, S. J., Sauer, J., Granger, A. and Howard, R. J. (2001). Increased first-contact rates for very-late-onset schizophrenia-like psychosis in African- and Caribbean-born elders. British Journal of Psychiatry, 179, 172–174.Google Scholar
Reeves, S., Stewart, R. and Howard, R. (2002). Service contact and psychopathology in very-late-onset schizophrenia-like psychosis: the effects of gender and ethnicity. International Journal of Geriatric Psychiatry, 17, 473–479.Google Scholar
Roth, M. and Morrisey, J. D. (1952). Problems in the diagnosis and classification of mental disorders in old age. Journal of Mental Science, 98, 66–80.Google Scholar
Taylor, M. A. (2001). Late-onset schizophrenia-like psychosis. American Journal of Psychiatry, 158, 1334–1335.Google Scholar