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Psychosis in the Elderly

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Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches

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Abstract

Psychosis in the elderly represents a frequent and challenging feature, with a prevalence of psychotic symptoms that may reach 10–63% in the hospitalized population. However, both the diagnosis and the treatment of psychotic symptoms in the elder population may present many problems.

In the present chapter, we debate the differential diagnosis between the causes of psychosis in the elderly and how to deal with them. The first cause of psychosis in this population is represented by dementia. Psychiatric symptoms may be present not only in the last phases of neurodegenerative disorders but also in the early stages or at onset, more frequently in specific subtypes of dementia, such as frontotemporal dementia. The second most common cause of psychosis in the geriatric population is depression, while delirium is the third. Delirium, differently from the other described diagnoses, is characterized by an acute change in mental status, disturbances of consciousness, and clouded sensorium and may be caused by several circumstances, ranging from infections to inappropriate medication use.

Considering the background of the present literature, we report the case of a 66-year-old man who was referred to our inpatient clinic for a manic episode with delusions. We investigated the differential diagnostic processes, which encompass a comprehensive clinical evaluation, a very accurate anamnestic interview, blood tests, and eventually brain imaging. Another major issue of concern is treatment, which might be guided by a multidisciplinary endeavor, including pharmacological and non-pharmacological interventions.

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References

  1. Mintzer J, Targum S. Psychosis in elderly patients: classification and pharmacotherapy. J Geriatr Psychiatry Neurol. 2003;16:199–206.

    Article  PubMed  Google Scholar 

  2. Broadway J, Mintzer J. The many faces of psychosis in the elderly. Curr Opin Psychiatry. 2007;20(6):551–8. [Review]

    Article  PubMed  Google Scholar 

  3. Ostling S, Borjesson-Hanson A, Skoog I. Psychotic symptoms and paranoid ideation in a population-based sample of 95-year-olds. Am J Geriatr Psychiatry. 2007;15:999–1004.

    Article  PubMed  Google Scholar 

  4. Kyomen HH, Whitfield TH. Psychosis in the elderly. Am J Psychiatry. 2009;166(2):146–50.

    Article  PubMed  Google Scholar 

  5. Bennett S, Thomas AJ. Depression and dementia: cause, consequence or coincidence? Maturitas. 2014;79(2):184–90.

    Article  PubMed  Google Scholar 

  6. Murray PS, Kumar S, Demichele-Sweet MAA, Sweet RA. Psychosis in Alzheimer’s disease. Biol Psychiatry. 2014;75(7):542–52.

    Article  PubMed  Google Scholar 

  7. Grau-Rivera O, Gelpi E, Carballido-López E, Sánchez-Valle R, López-Villegas MD. Rapidly progressive dementia with psychotic onset in a patient with the C9ORF72 mutation. Clin Neuropathol. 2015;34(5):294–7.

    Article  PubMed  Google Scholar 

  8. Gossink FT, Vijverberg EG, Krudop W, Scheltens P, Stek ML, Pijnenburg YA, Dols A. Psychosis in behavioral variant frontotemporal dementia. Neuropsychiatr Dis Treat. 2017;13:1099–106.

    Article  PubMed  Google Scholar 

  9. Galimberti D, Dell'Osso B, Altamura AC, Scarpini E. Psychiatric symptoms in frontotemporal dementia: epidemiology, phenotypes, and differential diagnosis. Biol Psychiatry. 2015;78(10):684–92.

    Article  PubMed  Google Scholar 

  10. Hall D, Finger EC. Psychotic symptoms in frontotemporal dementia. Curr Neurol Neurosci Rep. 2015;15(7):46.

    Article  PubMed  Google Scholar 

  11. Shinagawa S, Nakajima S, Plitman E, Graff-Guerrero A, Mimura M, Nakayama K, Miller BL. Psychosis in frontotemporal dementia. J Alzheimers Dis. 2014;42(2):485–99.

    Article  PubMed  Google Scholar 

  12. Mulsant BH, Ganguli M. Epidemiology and diagnosis of depression in late life. J Clin Psychiatry. 1999;20:9–15.

    Google Scholar 

  13. Wohlreich MM, Mallinckrodt CH, Watkin JG, et al. Duloxetine for the long-term management of major depressive disorder in patients aged 65 and older: an open-label study. BMC Geriatr. 2004;4:11.

    Article  PubMed  Google Scholar 

  14. Gournellis R, Lykouras L, Fortos A, Oulis P, Roumbos V, Christodoulou GN. Psychotic (delusional) major depression in late life: a clinical study. Int J Geriatr Psychiatry. 2001;16(11):1085–91.

    Article  CAS  PubMed  Google Scholar 

  15. Kessing L. Differences in diagnostic subtypes among patients with late and early onset of a single depressive episode. Int J Geriatr Psychiatry. 2006;21:1127–31.

    Article  PubMed  Google Scholar 

  16. Heser K, Tebarth F, Wiese B, Eisele M, Bickel H, Köhler M, Mösch E, Weyerer S, Werle J, König HH, Leicht H, Pentzek M, Fuchs A, Riedel-Heller SG, Luppa M, Prokein J, Scherer M, Maier W. Wagner M; age CoDe study group. Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German study on ageing, cognition, and dementia in primary care patients (AgeCoDe). Psychol Med. 2013;43(8):1597–610.

    Article  CAS  PubMed  Google Scholar 

  17. Kukreja D, Günther U, Popp J. Delirium in the elderly: current problems with increasing geriatric age. Indian J Med Res. 2015;142(6):655–62.

    Article  PubMed  Google Scholar 

  18. Morandi A, Di Santo SG, Cherubini A, Mossello E, Meagher D, Mazzone A, Bianchetti A, Ferrara N, Ferrari A, Musicco M, Trabucchi M, Bellelli G, ISGoD Group. Clinical features associated with delirium motor subtypes in older inpatients: results of a Multicenter study. Am J Geriatr Psychiatry. 2017;25(10):1064–71.

    Article  PubMed  Google Scholar 

  19. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911–22.

    Article  PubMed  Google Scholar 

  20. By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.

    Article  Google Scholar 

  21. Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults. Lancet Neurol. 2015;14(8):823–32.

    Article  PubMed  Google Scholar 

  22. Gavazzi G, Delerce E, Cambau E, François P, Corroyer B, de Wazières B, Fougère B, Paccalin M, Gaillat J. Diagnostic criteria for urinary tract infection in hospitalized elderly patients over 75 years of age: a multicenter cross-sectional study. Med Mal Infect. 2013;43(5):189–94.

    Article  CAS  PubMed  Google Scholar 

  23. Barthel H, Schroeter ML, Hoffmann KT, Sabri O. PET/MR in dementia and other neurodegenerative diseases. Semin Nucl Med. 2015;45(3):224–33.

    Article  PubMed  Google Scholar 

  24. Linjakumpu T, Hartikainen S, Klaukka T, et al. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002;55:809–17.

    Article  PubMed  Google Scholar 

  25. Rovera C, Mauri MC, Bertin E, Di Pace C, Paletta S, Reggiori A, De Gaspari IF, Cattaneo D, Mari D, Altamura AC. Duloxetine in elderly major depression disorder: effectiveness and drug plasma level evaluation. Hum Psychopharmacol. 2016;31(5):349–55.

    Article  CAS  PubMed  Google Scholar 

  26. Bellivier F, Golmard JL, Rietschel M, Schulze TG, Malafosse A, Preisig M, McKeon P, Mynett-Johnson L, Henry C, Leboyer M. Age at onset in bipolar I affective disorder: further evidence for three subgroups. Am J Psychiatry. 2003;160(5):999–1001.

    Article  PubMed  Google Scholar 

  27. Carlino AR, Stinnett JL, Kim DR. New onset of bipolar disorder in late life. Psychosomatics. 2013 Jan–Feb;54(1):94–7.

    Article  PubMed  Google Scholar 

  28. Besga A, Gonzalez I, Echeburua E, Savio A, Ayerdi B, Chyzhyk D, Madrigal JL, Leza JC, Graña M, Gonzalez-Pinto AM. Discrimination between Alzheimer's disease and late onset bipolar disorder using multivariate analysis. Front Aging Neurosci. 2015;7:231.

    Article  PubMed  Google Scholar 

  29. Hahn C, Lim HK, Lee CU. Neuroimaging findings in late-onset schizophrenia and bipolar disorder. J Geriatr Psychiatry Neurol. 2014;27(1):56–62.

    Article  PubMed  Google Scholar 

  30. Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ. 2015;350:h369.

    Article  PubMed  Google Scholar 

  31. Besga A, Chyzhyk D, Gonzalez-Ortega I, Echeveste J, Graña-Lecuona M, Graña M, Gonzalez-Pinto A. White matter tract integrity in Alzheimer's disease vs. late onset bipolar disorder and its correlation with systemic inflammation and oxidative stress biomarkers. Front Aging Neurosci. 2017;9:179.

    Article  PubMed  Google Scholar 

  32. Galimberti D, Prunas C, Paoli RA, Dell'Osso B, Fenoglio C, Villa C, Palazzo C, Cigliobianco M, Camuri G, Serpente M, Scarpini E, Altamura AC. Progranulin gene variability influences the risk for bipolar I disorder, but not bipolar II disorder. Bipolar Disord. 2014a;16(7):769–72.

    Article  CAS  PubMed  Google Scholar 

  33. Galimberti D, Reif A, Dell'Osso B, Palazzo C, Villa C, Fenoglio C, Kittel-Schneider S, Leonhard C, Olmes DG, Serpente M, Paoli RA, Altamura AC, Scarpini E. C9ORF72 hexanucleotide repeat expansion as a rare cause of bipolar disorder. Bipolar Disord. 2014b;16(4):448–9.

    Article  PubMed  Google Scholar 

  34. Rubino E, Vacca A, Gallone S, Govone F, Zucca M, Gai A, Ferrero P, Fenoglio P, Giordana MT, Rainero I. Late onset bipolar disorder and frontotemporal dementia with mutation in progranulin gene: a case report. Amyotroph Lateral Scler Frontotemporal Degener. 2017;18:1–3.

    Article  Google Scholar 

  35. Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002;8(3):448–60.

    Article  PubMed  Google Scholar 

  36. Cheng ST. Cognitive reserve and the prevention of dementia: the role of physical and cognitive activities. Curr Psychiatry Rep. 2016;18(9):85.

    Article  PubMed  Google Scholar 

  37. Goodwin GM, Abbar M, Schlaepfer TE, Grunze H, Licht RW, Bellivier F, Fountoulakis KN, Altamura AC, Pitchot W, Ågren H, Holsboer-Trachsler E, Vieta E. Aripiprazole in patients with bipolar mania and beyond: an update of practical guidance. Curr Med Res Opin. 2011;27(12):2285–99.

    Article  CAS  PubMed  Google Scholar 

  38. Wu CS, Hsieh MH, Tang CH, Chang CJ. Comparative effectiveness of long-acting injectable risperidone vs. long-acting injectable first-generation antipsychotics in bipolar disorder. J Affect Disord. 2016;197:189–95.

    Article  CAS  PubMed  Google Scholar 

  39. Kishi T, Oya K, Iwata N. Long-acting injectable antipsychotics for prevention of relapse in bipolar disorder: a systematic review and meta-analyses of randomized controlled trials. Int J Neuropsychopharmacol. 2016;19(9)

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Chiara Rovera & Alessandro Pigoni

Authors
  1. Chiara Rovera
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  2. Alessandro Pigoni
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Editor information

Editors and Affiliations

  1. Department of Neuroscience and Mental Health, IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Alfredo Carlo Altamura

  2. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy, IRCCS “E. Medea” Scientific Institute, Bosisio Parini (Lc), Italy

    Paolo Brambilla

Self-Assessment Questionnaire

Self-Assessment Questionnaire

  1. 1.

    What is the best therapeutic option for the stabilization of late-onset bipolar disorder?

    • (A) Lithium

    • (B) Valproic acid

    • (C) Lamotrigine

    • (D) Antipsychotic

  2. 2.

    What is the most frequent differential diagnosis that could be confusing in an elderly person presenting psychotic symptoms?

    • (A) Dementia

    • (B) Unipolar depression

    • (C) Delirium

    • (D) Brain neoplasia

  3. 3.

    What is the most frequent volumetric difference found between late-onset bipolar disorder and early-onset bipolar disorder?

    • (A) Frontal and temporal regions and white matter hyperintensities

    • (B) Cerebellum

    • (C) Basal ganglia

    • (D) Specifically prefrontal cortex

  4. 4.

    Which is the most reliable clinical scale evaluation for psychotic symptoms in bipolar disorder?

    • (A) PANSS

    • (B) YMRS

    • (C) BPRS

    • (D) WHO DAS

  5. 5.

    Which is the most important clinical domain among the following for evaluation in the follow-up after the clinical stabilization of the patient?

    • (A) Cardiological aspect

    • (B) Cognition

    • (C) Plasma level

    • (D) Endocrinological aspect

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Rovera, C., Pigoni, A. (2019). Psychosis in the Elderly. In: Altamura, A., Brambilla, P. (eds) Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches. Springer, Cham. https://doi.org/10.1007/978-3-319-91557-9_3

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  • DOI: https://doi.org/10.1007/978-3-319-91557-9_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91556-2

  • Online ISBN: 978-3-319-91557-9

  • eBook Packages: MedicineMedicine (R0)

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