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Schizophrenia Spectrum and Other Psychotic Disorders

  • Michael Reinhardt
  • Dina Ghoneim
  • Bronwyn Huggins
  • Anup Mani
  • Tessa Murante
  • Carl Cohen
Chapter

Abstract

The diagnostic category “schizophrenia spectrum and other psychotic disorders” comprises a group of conditions spanning both primary mental disorders and those secondary to other medical conditions. Within the population of older adults, the symptoms of psychosis are highly prevalent, etiologically heterogeneous, clinically diverse, and the sources of marked excess morbidity and mortality. Approximately 5–62% of elders, dependent on the population sampled, will experience newly incident psychosis. With the aging of our global population, the prevalence of psychotic disorders is only expected to rise—along with the attendant personal and social costs. Clinically, these conditions likely represent the manifestation of interactions between genetic, neurodevelopmental, neurophysiological aging, physical comorbidities, environmental, and social influences—with up to 60% of these cases attributable to other medical conditions. The inherent complexity and fragile nature of the geriatric patient with psychosis necessitate comprehensive assessment combined with a treatment approach that prioritizes non-pharmacological management. Antipsychotic medications, when necessary, should be used in combination with other treatment modalities, utilizing the smallest effective dosage, with attempts to further minimize dosing made at regular intervals. This chapter focuses its review on the epidemiology, pathophysiology, clinical presentation, and diagnosis of the primary psychotic disorders in older adults, including schizophrenia, schizoaffective disorder, and delusional disorder.

Keywords

Schizophrenia Late-onset schizophrenia Very late-onset schizophrenia-like psychosis schizoaffective disorder Delusional disorder Psychosis Elderly Geriatric Late life 

References

  1. 1.
    Bürgy M. The concept of psychosis: historical and phenomenological aspects. Schizophr Bull. 2008;34(6):1200–10.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Association, A.P. Diagnostic and statistical manual of mental disorders (DSM-5®). Virginia: American Psychiatric Pub; 2013.CrossRefGoogle Scholar
  3. 3.
    Holroyd S, Laurie S. Correlates of psychotic symptoms among elderly outpatients. Int J Geriatr Psychiatry. 1999;14(5):379–84.CrossRefPubMedGoogle Scholar
  4. 4.
    Webster R, Holroyd S. Prevalence of psychotic symptoms in delirium. Psychosomatics. 2000;41(6):519–22.CrossRefPubMedGoogle Scholar
  5. 5.
    Östling S, et al. Paranoid symptoms and hallucinations among the older people in Western Europe. Int J Geriatr Psychiatry. 2013;28(6):573–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Reinhardt MM, Cohen CI. Late-life psychosis: diagnosis and treatment. Curr Psychiatry Rep. 2015;17(2):1.CrossRefPubMedGoogle Scholar
  7. 7.
    Manepalli JN, et al. Differential diagnosis of the older patient with psychotic symptoms. Pri Psychiatry. 2007;14(8):55–62.Google Scholar
  8. 8.
    Castle DJ, Murray RM. The epidemiology of late-onset schizophrenia. Schizophr Bull. 1993;19(4):691–700.CrossRefPubMedGoogle Scholar
  9. 9.
    Copeland JRM, et al. Schizophrenia and delusional disorder in older age: community prevalence, incidence, comorbidity, and outcome. Schizophr Bull. 1998;24(1):153–61.CrossRefPubMedGoogle Scholar
  10. 10.
    Maglione JE, Vahia IV, Jeste DV. Schizophrenia spectrum and other psychotic disorders. In: The American Psychiatric publishing textbook of geriatric psychiatry. 5th ed.; 2015.Google Scholar
  11. 11.
    Diwan S, et al. Depression in older adults with schizophrenia spectrum disorders: prevalence and associated factors. Am J Geriatr Psychiatry. 2007;15(12):991–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Cohen CI, et al. Schizophrenia in later life: clinical symptoms and social well-being. Psychiatr Serv. 2008;59(3):232–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Howard R, et al. Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. Am J Psychiatr. 2000;157(2):172–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Harris MJ, Jeste DV. Late-onset schizophrenia: an overview. Schizophr Bull. 1988;14(1):39.CrossRefPubMedGoogle Scholar
  15. 15.
    Jeste DV, Wolkowitz OM, Palmer BW. Divergent trajectories of physical, cognitive, and psychosocial aging in schizophrenia. Schizophr Bull. 2011;37(3):451–5.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Palmer BW, McClure FS, Jeste DV. Schizophrenia in late life: findings challenge traditional concepts. Harv Rev Psychiatry. 2001;9(2):51–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Vahia IV, et al. Is late-onset schizophrenia a subtype of schizophrenia? Acta Psychiatr Scand. 2010;122(5):414–26.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Howard R, Almeida O, Levy R. Phenomenology, demography and diagnosis in late paraphrenia. Psychol Med. 1994;24(02):397–410.CrossRefPubMedGoogle Scholar
  19. 19.
    Rajji TK, Mulsant BH. Nature and course of cognitive function in late-life schizophrenia: a systematic review. Schizophr Res. 2008;102(1):122–40.CrossRefPubMedGoogle Scholar
  20. 20.
    Meesters PD, et al. Schizophrenia spectrum disorders in later life: prevalence and distribution of age at onset and sex in a dutch catchment area. Am J Geriatr Psychiatr. 2012;20(1):18–28.CrossRefGoogle Scholar
  21. 21.
    Post F. Schizo-affective symptomatology in late life. Br J Psychiatry. 1971;118(545):437–45.CrossRefPubMedGoogle Scholar
  22. 22.
    Gupta S, et al. Comparison of older patients with bipolar disorder and schizophrenia/schizoaffective disorder. Am J Geriatr Psychiatry. 2007;15(7):627–33.CrossRefPubMedGoogle Scholar
  23. 23.
    Baran XY, Young RC. Bipolar and depressive types of schizoaffective disorder in old age. Am J Geriatr Psychiatr. 2006;14(4):382–3.CrossRefGoogle Scholar
  24. 24.
    Kendler KS. Demography of paranoid psychosis (delusional disorder): a review and comparison with schizophrenia and affective illness. Arch Gen Psychiatry. 1982;39(8):890–902.CrossRefPubMedGoogle Scholar
  25. 25.
    Perälä J, et al. Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry. 2007;64(1):19–28.CrossRefPubMedGoogle Scholar
  26. 26.
    Maher B. Delusional thinking and cognitive disorder. Integr Physiol Behav Sci. 2005;40(3):136–46.CrossRefPubMedGoogle Scholar
  27. 27.
    Brunelle S, Cole MG, Elie M. Risk factors for the late-onset psychoses: a systematic review of cohort studies. Int J Geriatr Psychiatry. 2012;27(3):240–52.CrossRefPubMedGoogle Scholar
  28. 28.
    Jeste DV, et al. Nondementia nonpraecox dementia praecox?: late-onset schizophrenia. Am J Geriatr Psychiatry. 1997;5(4):302–17.CrossRefPubMedGoogle Scholar
  29. 29.
    Lohr JB, et al. Minor physical anomalies in older patients with late-onset schizophrenia, early-onset schizophrenia, depression, and Alzheimer's disease. Am J Geriatr Psychiatry. 1997;5(4):318–23.CrossRefPubMedGoogle Scholar
  30. 30.
    MacDonald AW, Schulz SC. What we know: findings that every theory of schizophrenia should explain. Schizophr Bull. 2009;35(3):493–508.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Bienvenu O, Davydow D, Kendler K. Psychiatric ‘diseases’ versus behavioral disorders and degree of genetic influence. Psychol Med. 2011;41(01):33–40.CrossRefPubMedGoogle Scholar
  32. 32.
    Ripke S, et al. Biological insights from 108 schizophrenia-associated genetic loci. Nature. 2014;511(7510):421.CrossRefPubMedCentralGoogle Scholar
  33. 33.
    Bigdeli TB, et al. Genome-wide association study reveals greater polygenic loading for schizophrenia in cases with a family history of illness. Am J Med Genet B Neuropsychiatr Genet. 2016;171(2):276–89.CrossRefGoogle Scholar
  34. 34.
    Voisey J, et al. A novel DRD2 single-nucleotide polymorphism associated with schizophrenia predicts age of onset: HapMap tag-single-nucleotide polymorphism analysis. Genet Test Mol Biomarkers. 2012;16(2):77–81.CrossRefPubMedGoogle Scholar
  35. 35.
    Liebers DT, et al. Polygenic risk of schizophrenia and cognition in a population-based survey of older adults. Schizophr Bull. 2016;42(4):984–91.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    LEWIS DA, et al. Altered cortical glutamate neurotransmission in schizophrenia. Ann N Y Acad Sci. 2003;1003(1):102–12.CrossRefPubMedGoogle Scholar
  37. 37.
    Harrison PJ. The hippocampus in schizophrenia: a review of the neuropathological evidence and its pathophysiological implications. Psychopharmacology. 2004;174(1):151–62.CrossRefPubMedGoogle Scholar
  38. 38.
    Ingvar D, Franzén G. Distribution of cerebral activity in chronic schizophrenia. Lancet. 1974;304(7895):1484–6.CrossRefGoogle Scholar
  39. 39.
    Sachdev P, et al. Schizophrenia with onset after age 50 years. 2: neurological, neuropsychological and MRI investigation. Br J Psychiatry. 1999;175(5):416–21.CrossRefPubMedGoogle Scholar
  40. 40.
    Corey-Bloom J, et al. Quantitative magnetic resonance imaging of the brain in late-life schizophrenia. Am J Psychiatr. 1995;152(3):447–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Chen L, et al. White matter microstructural abnormalities in patients with late-onset schizophrenia identified by a voxel-based diffusion tensor imaging. Psychiatry Res Neuroimaging. 2013;212(3):201–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Wake R, et al. Regional cerebral blood flow in late-onset schizophrenia: a SPECT study using 99mTc-ECD. Eur Arch Psychiatry Clin Neurosci. 2016;266(1):3–12.CrossRefPubMedGoogle Scholar
  43. 43.
    Tordesillas-Gutierrez D, et al. Grey matter volume differences in non-affective psychosis and the effects of age of onset on grey matter volumes: a voxelwise study. Schizophr Res. 2015;164(1):74–82.CrossRefPubMedGoogle Scholar
  44. 44.
    Hahn C, Lim HK, Lee CU. Neuroimaging findings in late-onset schizophrenia and bipolar disorder. J Geriatr Psychiatry Neurol. 2014;27(1):56–62.CrossRefPubMedGoogle Scholar
  45. 45.
    Howard RJ, et al. Quantitative magnetic resonance imaging volumetry distinguishes delusional disorder from late-onset schizophrenia. Br J Psychiatry. 1994;165(4):474–80.CrossRefPubMedGoogle Scholar
  46. 46.
    Grace AA. Dysregulation of the dopamine system in the pathophysiology of schizophrenia and depression. Nat Rev Neurosci. 2016;17(8):524–32.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Selvaraj S, et al. Alterations in the serotonin system in schizophrenia: a systematic review and meta-analysis of postmortem and molecular imaging studies. Neurosci Biobehav Rev. 2014;45:233–45.CrossRefPubMedGoogle Scholar
  48. 48.
    Wang Y, et al. Age-dependent decline of dopamine D1 receptors in human brain: a PET study. Synapse. 1998;30(1):56–61.CrossRefPubMedGoogle Scholar
  49. 49.
    Kaasinen V, et al. Age-related dopamine D2/D3 receptor loss in extrastriatal regions of the human brain. Neurobiol Aging. 2000;21(5):683–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Chang L, Jiang CS, Ernst T. Effects of age and sex on brain glutamate and other metabolites. Magn Reson Imaging. 2009;27(1):142–5.CrossRefPubMedGoogle Scholar
  51. 51.
    Iyo M, Yamasaki T. The detection of age-related decrease of dopamine D1, D2 and serotonin 5-HT2 receptors in living human brain. Prog Neuro-Psychopharmacol Biol Psychiatry. 1993;17(3):415–21.CrossRefGoogle Scholar
  52. 52.
    Wong DF, et al. Effects of age on dopamine and serotonin receptors measured by positron tomography in the living human brain. Science. 1984;226(4681):1393–6.CrossRefPubMedGoogle Scholar
  53. 53.
    Rinne JO, Lönnberg P, Marjamäki P. Age-dependent decline in human brain dopamine D1 and D2 receptors. Brain Res. 1990;508(2):349–52.CrossRefPubMedGoogle Scholar
  54. 54.
    Hof PR, Mobbs CV. Handbook of the neuroscience of aging. Burlington, MA: Academic Press; 2009.Google Scholar
  55. 55.
    Sailasuta N, Ernst T, Chang L. Regional variations and the effects of age and gender on glutamate concentrations in the human brain. Magn Reson Imaging. 2008;26(5):667–75.CrossRefPubMedGoogle Scholar
  56. 56.
    Yamamoto M, et al. Age-related decline of serotonin transporters in living human brain of healthy males. Life Sci. 2002;71(7):751–7.CrossRefPubMedGoogle Scholar
  57. 57.
    Wong DF, et al. Quantification of neuroreceptors in the living human brain: IV. Effect of aging and elevations of D2-like receptors in schizophrenia and bipolar illness. J Cereb Blood Flow Metab. 1997;17(3):331–42.CrossRefPubMedGoogle Scholar
  58. 58.
    Wong DF, et al. Quantification of neuroreceptors in the living human brain: III. D2-like dopamine receptors: theory, validation, and changes during normal aging. J Cereb Blood Flow Metab. 1997;17(3):316–30.CrossRefPubMedGoogle Scholar
  59. 59.
    Wang E, Snyder DS. Handbok of the aging brain. San Diego: Academic Press; 1998.Google Scholar
  60. 60.
    Finkelstein E, Prabhu M, Chen H. Increased prevalence of falls among elderly individuals with mental health and substance abuse conditions. Am J Geriatr Psychiatry. 2007;15(7):611–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Ayd FJ. A survey of drug-induced extrapyramidal reactions. JAMA. 1961;175(12):1054–60.CrossRefPubMedGoogle Scholar
  62. 62.
    Graff-Guerrero A, et al. Evaluation of antipsychotic dose reduction in late-life schizophrenia: a prospective dopamine D2/3 receptor occupancy study. JAMA Psychiat. 2015;72(9):927–34.CrossRefGoogle Scholar
  63. 63.
    Rajji TK, et al. Cognition and dopamine D 2 receptor availability in the striatum in older patients with schizophrenia. Am J Geriatr Psychiatry. 2017;25(1):1–10.CrossRefPubMedGoogle Scholar
  64. 64.
    Vahia IV, Lanouette NM, Jeste DV. Schizophrenia and paranoid disorders. In: Clinical manual of geriatric psychiatry. Virginia: American Psychiatric Publishing; 2013.Google Scholar
  65. 65.
    Marsh L, et al. Psychiatric comorbidities in patients with Parkinson disease and psychosis. Neurology. 2004;63(2):293–300.CrossRefPubMedGoogle Scholar
  66. 66.
    Robins LN, Regier DA. Psychiatric disorders in America: the epidemiologic catchment area study. New York: Free Press; 1991.Google Scholar
  67. 67.
    Copeland JRM, et al. Alzheimers-disease, other dementias, depression and pseudodementia - prevalence, incidence and 3-year outcome in liverpool. Br J Psychiatry. 1992;161:230–9.CrossRefPubMedGoogle Scholar
  68. 68.
    Iglewicz A, Meeks TW, Jeste DV. New wine in old bottle: late-life psychosis. Psychiatr Clin N Am. 2011;34(2):295–318.CrossRefGoogle Scholar
  69. 69.
    Harvey PD, et al. Cognitive decline in late-life schizophrenia: a longitudinal study of geriatric chronically hospitalized patients. Biol Psychiatry. 1999;45(1):32–40.CrossRefPubMedGoogle Scholar
  70. 70.
    Davidson M, et al. Severity of symptoms in chronically institutionalized geriatric schizophrenic patients. Am J Psychiatry. 1995;152(2):197–207.CrossRefPubMedGoogle Scholar
  71. 71.
    Uchida H, et al. Sensitivity of older patients to antipsychotic motor side effects: a PET study examining potential mechanisms. Am J Geriatr Psychiatry. 2009;17(3):255–63.CrossRefPubMedGoogle Scholar
  72. 72.
    Uchida H, et al. Therapeutic window for striatal dopamine D 2/3 receptor occupancy in older patients with schizophrenia: a pilot PET study. Am J Geriatr Psychiatry. 2014;22(10):1007–16.CrossRefPubMedGoogle Scholar
  73. 73.
    Jeste DV. Tardive dyskinesia in older patients. J Clin Psychiatry. 2000;61(Suppl 4):27–32.PubMedGoogle Scholar
  74. 74.
    Meesters PD, et al. Mortality and its determinants in late-life schizophrenia: a 5-year prospective study in a Dutch catchment area. Am J Geriatr Psychiatry. 2016;24(4):272–7.CrossRefPubMedGoogle Scholar
  75. 75.
    Talaslahti T, et al. Patients with very-late-onset schizoprhenia-like psychosis have higher mortality rates than elderly patients with earlier onset schizophrenia. Int J Geriatr Psychiatry. 2015;30(5):453–9.CrossRefPubMedGoogle Scholar
  76. 76.
    Sadock BJ, Ruiz P, Sadock VA. In: Sadock BJ, Ruiz P, Sadock VA, editors. Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2015.Google Scholar
  77. 77.
    Jeste D, et al. Conventional vs. newer antipsychotics in elderly patients. Am J Geriatr Psychiatry. 1999;7(1):70.CrossRefPubMedGoogle Scholar
  78. 78.
    Lehman AF, et al. Practice guideline for the treatment of partients with schizophrenia. Am J Psychiatr. 2004;161(2 Suppl):1–56.PubMedGoogle Scholar
  79. 79.
    Essali A, Ali G. Antipsychotic drug treatment for elderly people with late-onset schizophrenia. Cochrane Database Syst Rev. 2012;2:CD004162.Google Scholar
  80. 80.
    Rothenberg KG, et al. Clozapine in geriatric population-clinical indication and safety monitoring. Am J Geriatr Psychiatry. 22(3):S73–S74.Google Scholar
  81. 81.
    Tzimos A, et al. Safety and tolerability of oral paliperidone extended-release tablets in elderly patients with schizophrenia: a double-blind, placebo-controlled study with six-month open-label extension. Am J Geriatr Psychiatry. 2008;16(1):31–43.CrossRefPubMedGoogle Scholar
  82. 82.
    Alexopoulos GS, Streim JE, Carpenter D. Commentary: expert consensus guidelines for using antipsychotic agents in older patients. J Clin Psychiatry. 2004;65(suppl 2):100–2.Google Scholar
  83. 83.
    Takeuchi H, et al. Effects of risperidone and olanzapine dose reduction on cognitive function in stable patients with schizophrenia: an open-label, randomized, controlled, pilot study. Schizophr Bull. 2013;39(5):993–8.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Granholm E, et al. A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. Am J Psychiatry. 2005;162(3):520–9.CrossRefPubMedGoogle Scholar
  85. 85.
    Granholm E, et al. Randomized controlled trial of cognitive behavioral social skills training for older people with schizophrenia: 12-month follow-up. J Clin Psychiatry. 2007;68(5):730–7.CrossRefPubMedGoogle Scholar
  86. 86.
    Patterson TL, et al. Functional Adaptation Skills Training (FAST): a randomized trial of a psychosocial intervention for middle-aged and older patients with chronic psychotic disorders. Schizophr Res. 2006;86(1–3):291–9.CrossRefPubMedGoogle Scholar
  87. 87.
    Bartels SJ, et al. Long-term outcomes of a randomized trial of integrated skills training and preventive healthcare for older adults with serious mental illness. Am J Geriatr Psychiatry. 2014;22(11):1251–61.CrossRefPubMedGoogle Scholar
  88. 88.
    Mueser KT, et al. Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness. J Consult Clin Psychol. 2010;78(4):561–73.CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Cohen-Mansfield J, Libin A, Marx MS. Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention. J Gerontol A Biol Sci Med Sci. 2007;62(8):908–16.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Michael Reinhardt
    • 1
  • Dina Ghoneim
    • 1
  • Bronwyn Huggins
    • 1
  • Anup Mani
    • 1
  • Tessa Murante
    • 1
  • Carl Cohen
    • 1
  1. 1.SUNY Downstate Medical CenterBrooklynUSA

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