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Rep C, Dubertret C, Pignon B, Sleurs D, Tebeka S, Le Strat Y. Psychotic-like experiences in general population: Psychiatric comorbidity and impact on quality of life across lifespan. Schizophr Res 2023; 256:52-62. [PMID: 37150148 DOI: 10.1016/j.schres.2023.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/23/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND HYPOTHESIS In this study, we aimed to determine the prevalence of Psychotics-Like Experiences according to age group and their association with psychiatric disorders through these different age-group, as well as their impact on quality of life. STUDY DESIGN Using data from the second wave of the NESARC, a large general population study, we considered 6 mutually exclusive groups according to the age at the interview: 20-29 years; 30-39 years; 40-49 years; 50-59 years; 60-69 years; 70+ years. We determined the frequency of PLEs defined as positive, negative, depressive, mania and disorganization symptoms with reference to the PANSS, and the association between the presence of PLEs in the previous year and the presence of lifetime psychiatric disorders and quality of life across different age groups. STUDY RESULTS The prevalence of PLEs decreased across age from a 34.7 % in the 20-29 years age group, to 19.7 % in the 70+ years age group. Across all age groups, individuals who reported PLEs in the previous year had higher risk of having any psychiatric disorder, (i.e any mood disorder, any anxiety disorder any substance abuse and any personality disorder) compared to individuals not reporting PLEs. All dimensions of quality of life on the SF12 scale were negatively associated with the presence of a PLE regardless of age group. CONCLUSION We found that the frequency of PLEs decreased with age and that the presence of PLE is associated with psychiatric disorders and with impaired quality of life in all age groups.
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Affiliation(s)
- Cécile Rep
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France.
| | - Caroline Dubertret
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, France
| | - Baptiste Pignon
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France
| | - David Sleurs
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, France
| | - Sarah Tebeka
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, France
| | - Yann Le Strat
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, France
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Armstrong NM, Vieira Ligo Teixeira C, Gendron C, Brenowitz WD, Lin FR, Swenor B, Powell DS, Deal JA, Simonsick EM, Jones RN. Associations of dual sensory impairment with long-term depressive and anxiety symptoms in the United States. J Affect Disord 2022; 317:114-122. [PMID: 35932940 PMCID: PMC10696594 DOI: 10.1016/j.jad.2022.07.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We explored the associations of dual sensory impairment (DSI) with long-term depressive and anxiety symptoms as well as low perceived social support (LPSS) as a modifier of these associations. METHODS Multinomial logistic regression models were used to examine the associations of DSI and single sensory impairment (hearing [pure-tone average > 25 dB] and vision [impaired visual acuity and/or contrast sensitivity]) with long-term depressive symptom (≥8 on the 10-item Center for Epidemiologic Studies-Depression Scale) and anxiety symptom (present on the Hopkins Symptom Checklist) latent classes from group-based trajectory models (rare/never; mild/moderate increasing; chronically high) among 2102 Health, Aging and Body Composition Study participants (mean age:74.0 ± 2.8 years; 51.9 % female) over 10 years. Models were adjusted by demographic characteristics and cardiovascular risk factors, and LPSS. An additional model evaluated the two-way interaction between DSI and LPSS. RESULTS DSI was associated with increased risk of being chronically depressed (Risk Ratio, RR = 1.99, 95 % Confidence Interval, CI: 1.25, 3.17), not mild/moderate increasingly depressed (RR = 1.25, 95 % CI: 0.91, 1.71). DSI had increased risk of being mild/moderate increasingly anxious (RR = 1.60, 95 % CI: 1.16, 2.19) and chronically anxious (RR = 1.86, 95 % CI: 1.05, 3.27) groups, as compared to no impairments. Hearing impairment was associated with being mild/moderate increasingly anxious (RR = 1.34, 95 % CI: 1.01, 1.79). No other associations were found for single sensory impairments. LPSS did not modify associations. LIMITATIONS Sensory measures were time-fixed, and LPSS, depression and anxiety measures were self-reported. CONCLUSIONS Future research is warranted to determine if DSI therapies may lessen long-term chronically high depressive and anxiety symptoms.
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Affiliation(s)
- Nicole M Armstrong
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | | | - Colby Gendron
- Department of Economics, Brown University, Providence, RI, USA
| | - Willa D Brenowitz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bonnelin Swenor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Disability Health Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Danielle S Powell
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Shoham N, Eskinazi M, Hayes JF, Lewis G, Theodorsson M, Cooper C. Associations between psychosis and visual acuity impairment: A systematic review and meta-analysis. Acta Psychiatr Scand 2021; 144:6-27. [PMID: 34028803 PMCID: PMC8504204 DOI: 10.1111/acps.13330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Several theories propose that visual acuity impairment is associated with psychosis. Visual impairment could lead to psychosis or the converse, or they may share underlying pathology or risk factors. In the first evidence synthesis in this area for over 25 years, we collated studies measuring the association between visual acuity impairment and psychosis. METHODS We searched the MEDLINE, EMBASE, PsycINFO, and Web of Science databases for studies published from 1992 to 2020, using the Newcastle Ottawa Scale to assess risk of bias. We narratively synthesized findings and meta-analyzed sufficiently homogenous results. RESULTS We included 40 papers, which reported on 31 studies. Evidence from seven cohort studies was inconsistent, which precluded meta-analysis of this study design. These contradictory results also made it difficult to draw conclusions regarding a temporal association. We found evidence for an association from eight cross-sectional studies treating visual acuity impairment as the exposure and psychosis as the outcome [pooled odds ratio (OR) =1.76, 95% confidence interval (CI): 1.34-2.31], and four with the reverse exposure and outcome (OR: 1.85, 95% CI: 1.17-2.92). Seven case-control studies with mixed findings were found, but only two primarily addressed our research question, and these findings were mixed. CONCLUSIONS Although evidence supports a cross-sectional association between visual acuity impairment and psychosis, further research is needed to clarify the temporal direction, given the mixed findings in cohort studies. Understanding the association may give insights into prevention strategies for people at risk of visual acuity impairment and psychosis.
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Affiliation(s)
- Natalie Shoham
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | - Michelle Eskinazi
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | - Joseph F. Hayes
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | - Gemma Lewis
- Division of PsychiatryUniversity College LondonLondonUK
| | | | - Claudia Cooper
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
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Östling S, Bäckman K, Sigström R, Skoog I. Is the prevalence of psychosis in the very old decreasing? A comparison of 85-year-olds born 22 years apart. Int J Geriatr Psychiatry 2019; 34:1776-1783. [PMID: 31392744 DOI: 10.1002/gps.5192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/06/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To elucidate whether there is a decrease of psychotic symptoms in 85-years-olds without dementia and if factors associated with psychotic symptoms have changed, we studied two birth cohorts of 85-year-olds born 22 years apart. METHODS Every second, 85-year-olds in Gothenburg, Sweden was invited to neuropsychiatric examinations in 1986 to 1987 (participation 63.1%, N = 494) and in 2008 to 2010 (60.5%, N = 571). A close informant was interviewed by a psychiatrist or a research psychologist. RESULTS The prevalence of psychotic symptoms in 85-years-olds without dementia decreased from 10.1% in 1986 to 1987 to 3.2% in 2008 to 2010 (P < .001). Disability in daily life (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.1-4.5), depressed mood (OR, 3.9; 95% CI, 2.1-7.1), irritability (OR, 3.6; 95% CI, 1.2-10.5), and suicidal ideation (OR, 4.1; 95% CI, 2.1-8.0) were associated with psychotic symptoms in both cohorts. Mean mini-mental state examination (MMSE) score was lower in those with psychotic symptom compared with those with no psychotic symptoms (Cohort 1986-1987, 26.4 vs 27.8, Cohort 2008-2009, 26.1 vs 27.7, t value -4.24, Pr > t < 0.001). CONCLUSION The prevalence of psychotic symptoms decreased between 1986 to 1987 and 2008 to 2010 among 85-years-olds without dementia. These symptoms were associated with broad psychopathology, worse performance in cognitive testing, and with disability of daily life in both cohorts.
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Affiliation(s)
- Svante Östling
- Institute of Neuroscience and Physiology, Psychiatry and Neurochemistry Section, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Kristoffer Bäckman
- Institute of Neuroscience and Physiology, Psychiatry and Neurochemistry Section, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Robert Sigström
- Institute of Neuroscience and Physiology, Psychiatry and Neurochemistry Section, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Psychiatry and Neurochemistry Section, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
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Increased risk of psychosis in patients with hearing impairment: Review and meta-analyses. Neurosci Biobehav Rev 2015; 62:1-20. [PMID: 26743858 DOI: 10.1016/j.neubiorev.2015.12.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/24/2015] [Accepted: 12/24/2015] [Indexed: 12/12/2022]
Abstract
Several studies suggest hearing impairment as a risk factor for psychosis. Hearing impairment is highly prevalent and potentially reversible, as it can be easily diagnosed and sometimes improved. Insight in the association between hearing impairment and psychosis can therefore contribute to prevention of psychosis. This paper provides meta-analyses of all epidemiologic evidence on the association between hearing impairment and psychosis and summarizes mechanisms that potentially underlie this relationship. Meta-analyses showed an increased risk of hearing impairment on all psychosis outcomes, such as hallucinations (OR 1.40(95%CI 1.18-1.65; n=227,005)), delusions (OR 1.55(95%CI 1.36-1.78; n=250,470)), psychotic symptoms (OR 2.23(95%CI 1.83-2.72; n=229,647) and delirium (OR 2.67(95%CI 2.05-3.48; n=12,432). Early exposure to hearing impairment elevated the risk of later development of schizophrenia (OR 3.15(95%CI 1.25-7.95; n=50,490)). Potential mechanisms underlying this association include loneliness, diminished theory of mind, disturbances of source monitoring and top-down processing and deafferentiation. Early assessment and treatment of hearing impairment in patients with (high risk of) psychosis may be essential in psychosis treatment and prevention.
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Gilliver SC, Sundquist J, Li X, Sundquist K. Recent research on the mental health of immigrants to Sweden: a literature review. Eur J Public Health 2015; 24 Suppl 1:72-9. [PMID: 25108001 DOI: 10.1093/eurpub/cku101] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
UNLABELLED The arrival of large numbers of economic migrants and refugees has seen the Swedish immigrant population increase rapidly. Research has shown that immigrants may be more susceptible to mental disorders because of traumatic events prior to immigration and adverse circumstances in their new country. The aim of this literature review is to summarize and interpret recent research on the mental health of immigrants to Sweden. METHODS A systematic search for relevant literature in PubMed was performed on 13 February 2014. Relevant literature was limited to original research articles published between 1 January 1994 and 13 February 2014. Content relating to mental disorders and suicide was reviewed and summarized. RESULTS Nationwide studies showed increased risks of common mental disorders such as depression, as well as psychotic disorders, in immigrants to Sweden compared to native Swedes. However, the results are complex, with notable differences between different immigrant groups and between males and females. Risk of suicide was increased in some immigrant groups, but decreased in others. There has been little qualitative research on the mental health of immigrants and few intervention studies have targeted immigrants. CONCLUSION Immigrants to Sweden are a mixed group with differing, but often increased, risks of mental disorders. Targeted qualitative and intervention studies may facilitate efforts to develop and implement preventive methods for immigrants at high risk of mental ill health, and to tailor treatment to the specific needs of different immigrant groups.
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Affiliation(s)
- Stephen C Gilliver
- 1 Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University / Region Skåne, Malmö, Sweden
| | - Jan Sundquist
- 1 Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University / Region Skåne, Malmö, Sweden2 Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Xinjun Li
- 1 Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University / Region Skåne, Malmö, Sweden
| | - Kristina Sundquist
- 1 Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University / Region Skåne, Malmö, Sweden2 Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
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Soares WB, Ribeiz SRI, Bassitt DP, De Oliveira MC, Bottino CMC. Psychotic symptoms in older people without dementia from a Brazilian community-based sample. Int J Geriatr Psychiatry 2015; 30:437-45. [PMID: 24990116 DOI: 10.1002/gps.4156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/18/2014] [Accepted: 05/21/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The international prevalence of psychotic symptoms in older subjects without dementia varies from 0.9% to 8.0%. However, an analysis of these symptoms in developing countries has not been undertaken. AIMS To determine the prevalence and to correlate these symptoms with socioeconomic and clinical characteristics. METHOD A community-based sample aged 60 years and older was evaluated. Those who screened positive for dementia, cognitive and functional impairment or significant depressive symptoms were excluded, resulting in 1125 individuals. RESULTS The prevalence of psychotic symptoms was 9.1% (visual/tactile hallucinations, 7.8%; auditive hallucinations, 7.5%; persecutory delusions, 2.9%). Subjects with psychotic symptoms had lower Mini Mental State Examination and The Bayer Activities of Daily Living Scale scores, fewer years of schooling, belonged to lower socioeconomic classes compared with non-psychotic subjects, and 80% had clinical comorbidities. CONCLUSIONS The prevalence was in the upper range of international data. Significant relationships were found between psychotic symptoms and lower Mini Mental State Examination score, fewer years of schooling and lower socioeconomic class. Clinical comorbidity was also very frequent.
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Affiliation(s)
- Walter Barbalho Soares
- Old Age Research Group (PROTER), Institute of Psychiatry, University of São Paulo (USP), São Paulo, SP, Brazil; Department of Clinical Medicine, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
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Waters F, Collerton D, Ffytche DH, Jardri R, Pins D, Dudley R, Blom JD, Mosimann UP, Eperjesi F, Ford S, Larøi F. Visual hallucinations in the psychosis spectrum and comparative information from neurodegenerative disorders and eye disease. Schizophr Bull 2014; 40 Suppl 4:S233-45. [PMID: 24936084 PMCID: PMC4141306 DOI: 10.1093/schbul/sbu036] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 02/12/2014] [Accepted: 02/12/2014] [Indexed: 02/06/2023]
Abstract
Much of the research on visual hallucinations (VHs) has been conducted in the context of eye disease and neurodegenerative conditions, but little is known about these phenomena in psychiatric and nonclinical populations. The purpose of this article is to bring together current knowledge regarding VHs in the psychosis phenotype and contrast this data with the literature drawn from neurodegenerative disorders and eye disease. The evidence challenges the traditional views that VHs are atypical or uncommon in psychosis. The weighted mean for VHs is 27% in schizophrenia, 15% in affective psychosis, and 7.3% in the general community. VHs are linked to a more severe psychopathological profile and less favorable outcome in psychosis and neurodegenerative conditions. VHs typically co-occur with auditory hallucinations, suggesting a common etiological cause. VHs in psychosis are also remarkably complex, negative in content, and are interpreted to have personal relevance. The cognitive mechanisms of VHs in psychosis have rarely been investigated, but existing studies point to source-monitoring deficits and distortions in top-down mechanisms, although evidence for visual processing deficits, which feature strongly in the organic literature, is lacking. Brain imaging studies point to the activation of visual cortex during hallucinations on a background of structural and connectivity changes within wider brain networks. The relationship between VHs in psychosis, eye disease, and neurodegeneration remains unclear, although the pattern of similarities and differences described in this review suggests that comparative studies may have potentially important clinical and theoretical implications.
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Affiliation(s)
- Flavie Waters
- Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service Mental Health, Perth, Western Australia, Australia; Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, the University of Western Australia, Perth, Western Australia, Australia;
| | - Daniel Collerton
- Northumberland, Tyne and Wear NHS Foundation Trust, Bensham Hospital, Gateshead and Newcastle University, Newcastle Upon Tyne, UK
| | | | - Renaud Jardri
- Laboratoire de Neurosciences Fonctionnelles & Pathologies, Université Droit & Santé (UDSL), Univ Lille Nord de France and Centre Hospitalier Universitaire (CHU Lille), Hôpital Fontan, Lille, France
| | - Delphine Pins
- Laboratoire de Neurosciences Fonctionnelles & Pathologies, Université Droit & Santé (UDSL), Univ Lille Nord de France and Centre Hospitalier Universitaire (CHU Lille), Hôpital Fontan, Lille, France
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK; South of Tyne Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Jan Dirk Blom
- Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Urs Peter Mosimann
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Frank Eperjesi
- Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Stephen Ford
- Department of Psychiatry, Sir Charles Gairdner Hospital, North Metropolitan Health Service Mental Health - Older Adult Program, Perth, Western Australia, Australia
| | - Frank Larøi
- Department of Psychology: Cognition and Behaviour, University of Liège, Liège, Belgium
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Östling S, Bäckman K, Waern M, Marlow T, Braam AW, Fichter M, Lawlor BA, Lobos A, Reischies FM, Copeland JRM, Skoog I. Paranoid symptoms and hallucinations among the older people in Western Europe. Int J Geriatr Psychiatry 2013; 28:573-9. [PMID: 22911450 DOI: 10.1002/gps.3861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 06/25/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE It is not clear whether the prevalence of psychosis increases with age. We studied the age-specific prevalence of psychotic symptoms in older people in Western Europe. METHODS Older people without dementia (age 65-104 years, N = 8762) from the western part of Europe in the EURODEP concerted action took part in psychiatric examinations. RESULTS In total, 2.4% of the men and 2.9% of the women had psychotic symptoms. Using a multilevel logistic regression model that included gender and age as a continuous variable, we found that a 5-year increase in age increased the prevalence of psychotic symptoms (odds ratio 1.2 95% confidence interval 1.06-1.3, p = 0.001). A second multilevel regression model showed that wishing to be dead, depressed mood, functional disability, not being married and cognitive impairment measured with Mini mental state examination were all associated with psychotic symptoms whereas gender was not. CONCLUSION The prevalence of psychotic symptoms in non-demented older people increases with age, and these symptoms are associated with other psychopathology, social isolation and problems with daily living.
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Affiliation(s)
- Svante Östling
- Institute of Neuroscience and Physiology, Psychiatry Section, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Freeman D, McManus S, Brugha T, Meltzer H, Jenkins R, Bebbington P. Concomitants of paranoia in the general population. Psychol Med 2011; 41:923-936. [PMID: 20735884 DOI: 10.1017/s0033291710001546] [Citation(s) in RCA: 190] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Paranoia is an unregarded but pervasive attribute of human populations. In this study we carried out the most comprehensive investigation so far of the demographic, economic, social and clinical correlates of self-reported paranoia in the general population. METHOD Data weighted to be nationally representative were analysed from the Adult Psychiatric Morbidity Survey in England (APMS 2007; n=7281). RESULTS The prevalence of paranoid thinking in the previous year ranged from 18.6% reporting that people were against them, to 1.8% reporting potential plots to cause them serious harm. At all levels, paranoia was associated with youth, lower intellectual functioning, being single, poverty, poor physical health, poor social functioning, less perceived social support, stress at work, less social cohesion, less calmness, less happiness, suicidal ideation, a great range of other psychiatric symptoms (including anxiety, worry, phobias, post-traumatic stress and insomnia), cannabis use, problem drinking and increased use of treatment and services. CONCLUSIONS Overall, the results indicate that paranoia has the widest of implications for health, emotional well-being, social functioning and social inclusion. Some of these concomitants may contribute to the emergence of paranoid thinking, while others may result from it.
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Affiliation(s)
- D Freeman
- Institute of Psychiatry, King's College London, Denmark Hill, London, UK.
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Abstract
OBJECTIVE To determine the 1-month prevalence of mental disorders among 95-year olds. DESIGN Cross-sectional population sample of 95-year olds. SETTING : All 95-year olds born in the period 1901-1903 living in Gothenburg, Sweden, were invited. Elderly living in both community settings and nursing homes were included. PARTICIPANTS In total, 338 95-year olds (response rate: 65%) were examined (263 women, 75 men). MEASUREMENTS All participants were examined by psychiatrists using the Comprehensive Psychopathological Rating Scale and cognitive tests. Mental disorders were classified according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria. RESULTS Two-third of all 95-year olds had a mental disorder. In the total sample of 95-year olds, the 1-month prevalence was 52% for dementia, 8% for depression, 4% for anxiety, and 3% for psychotic disorders. Almost one-third (29%) of the nondemented 95-year olds fulfilled criteria for a psychiatric disorder: 17% had depression, 9% anxiety, and 7% psychotic disorder. CONCLUSIONS The combined prevalence of mental disorders was high among 95-year olds, even after excluding dementia. These findings emphasize the importance of research, care, and detection of psychiatric problems in this age group.
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Sigström R, Skoog I, Sacuiu S, Karlsson B, Klenfeldt IF, Waern M, Gustafson D, Ostling S. The prevalence of psychotic symptoms and paranoid ideation in non-demented population samples aged 70-82 years. Int J Geriatr Psychiatry 2009; 24:1413-9. [PMID: 19347837 DOI: 10.1002/gps.2278] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Recent population(Q3) studies have reported an approximate 10% prevalence of psychotic symptoms among elderly aged 85 years and older. Psychotic symptoms may be less prevalent among younger elderly. We examined the prevalence of psychotic symptoms in a population-based sample of non-demented elderly aged 70-82 years. METHODS A systematic Swedish population sample of 894 non-demented elderly (response rate 68%) representing three birth cohorts (340 women and 224 men aged 70 years and 330 women aged 78 and 82 years) was examined using the Comprehensive Psychopathological Rating Scale (CPRS), during a semi-structured psychiatric interview. A key informant interview was also conducted. Psychotic symptoms were classified according to the DSM-IV Glossary of technical terms. RESULTS The 1-year prevalence of any psychotic symptom was 0.9% among non-demented women and men aged 70 years, and 1.2% among women aged 78 and 82 years. Psychotic symptoms were not related to sex or age. The prevalence of paranoid ideation was 1.0%. Among women, any paranoid symptom (persecutory delusions or paranoid ideation) was more common in 70-year-olds (2.6%) than in 78-82-year-olds (0.6%) (p = 0.04). CONCLUSIONS Psychotic symptoms affected only 1% of this non-demented population aged 70, 78 and 82 years, which is lower than the 7-10% previously found among 85- and 95-year-olds. This might reflect a lower prevalence of psychotic symptoms compared to older elderly or secular changes resulting in lower prevalence of psychotic symptoms in later-born birth cohorts.
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Affiliation(s)
- Robert Sigström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sweden
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Müller MJ, Eich FX, Regenbogen B, Sachse J, Härtter S, Hiemke C. Amisulpride doses and plasma levels in different age groups of patients with schizophrenia or schizoaffective disorder. J Psychopharmacol 2009; 23:278-86. [PMID: 18562411 DOI: 10.1177/0269881108089806] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Because of a unique pharmacodynamic profile, amisulpride seems appropriate for treatment of elderly patients with schizophrenia. In a large-scale naturalistic therapeutic drug monitoring study, daily amisulpride dose, trough and dose-corrected amisulpride plasma levels, co-medication, clinical effectiveness (CGI) and side effects (UKU) were compared between age groups in 395 patients with schizophrenia or schizoaffective disorder (46% women; mean age 39.1 +/- 14.2 years, range 18-83 years) under amisulpride therapy. Mean amisulpride doses (574 +/- 269 mg/day), plasma levels (304 +/- 274 ng/mL), dose-corrected amisulpride plasma levels (C/D ratios, 0.52 +/- 0.41 ng/mL:mg), clinical response (at least moderate improvement, 71.6%), and side effects (any side effect, 32.2%; extrapyramidal symptoms, 14.9%) were comparable between age groups (P > 0.25). At higher age, significantly more benzodiazepines (P = 0.04), non-benzodiazepine hypnotics (P = 0.004) and non-psychotropic medications (P < 0.0001) were prescribed. The naturalistic study showed higher C/D ratios in women (P = 0.019) and a slight increase of C/D ratios with age (P = 0.026), but no substantial age-dependent effects on amisulpride doses or plasma levels. In patients above 60 years, clinical response was associated with lower amisulpride plasma levels (P = 0.016) at comparable doses. Neither the age-dependent decrease of amisulpride clearance nor the significantly higher prevalence of co-morbidity and co-medication seem to be the reasons for definite clinical concerns against amisulpride treatment of elderly if contraindications are seriously taken.
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Use of antipsychotic medications in older home-care patients. Report from nine European countries. Aging Clin Exp Res 2008; 20:260-5. [PMID: 18594194 DOI: 10.1007/bf03324781] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Data on the use of antipsychotics among older people in need of regular home care services are rare. The aim of this study was to ascertain the differences in the use and type of antipsychotic medications between European home-care sites. METHODS A cross-sectional study was designed by means of RAI (Resident Assessment Instrument for Home Care) assessments. A random sample of 3251 assessments was gathered during the period September 2001-January 2002 from home care patients aged 65 and over in nine European countries (Czech Republic, Denmark, Finland, Germany, Iceland, Italy, Netherlands, Norway and United Kingdom). RESULTS Two hundred of the home care patients (6.2%) received antipsychotic medication. The prevalence of the use of one or more antipsychotics varied widely between study sites, ranging from 3.0% in Denmark to 12.4% in Finland. Factors independently associated with the use of antipsychotics were: delusions (OR 3.09, 95% CI 1.66-5.76), any diagnosis of dementia (OR 2.57, 95% CI 1.70-3.87), youngest age group (65-74 yrs) (OR 2.37, 95% CI 1.53-3.66) and hallucinations (OR 2.28, 95% CI 1.17-4.45). Concomitant use of anxiolytics (OR 2.32, 95% CI 1.58- 3.41), hypnotics (OR 2.08, 95% CI 1.44-3.03) and antidepressants (OR 2.06, 95% CI 1.41-3.00) together with signs of depression (OR 1.78, 95% CI 1.24- 2.56), moderate to severe cognitive impairment (OR 1.30, 95% CI 1.12-1.51) and residing in Finland (OR 2.52, 95% CI 1.21-5.24) or Italy (OR 2.15, 95% CI 1.10-4.19) were associated with the use of antipsychotics. The most commonly used antipsychotic agent was risperidone (n=42, 21%). CONCLUSIONS The frequency of antipsychotic drug use in older home-care patients varied considerably among the European countries studied. Antipsychotic drug treatment in older home-care recipients seems to be less common than in residents in long-term institutional care, and more common than among the independently-living elderly.
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Alanen HM, Finne-Soveri H, Noro A, Leinonen E. Use of Antipsychotics in Older Home Care Patients in Finland. Drugs Aging 2008; 25:335-42. [DOI: 10.2165/00002512-200825040-00006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
OBJECTIVE To examine the 1-year prevalence of psychotic symptoms and schizophrenia in nondemented 95-year-olds, and to examine the relation between psychotic symptoms and other psychiatric symptoms, sensory impairments, and cognitive functioning. PARTICIPANTS The representative sample was 95-year-olds living in Göteborg, Sweden (N = 338). Individuals with dementia were excluded (N = 175), leaving 163 subjects for this study. DESIGN This was a cross-sectional population study, including psychiatric and physical examinations, cognitive tests, and interviews with close informants. MEASUREMENTS Diagnosis of schizophrenia, psychotic symptoms, paranoid ideation and dementia according to Diagnostic and Statistical Manual of Mental Disorders, Third Revision (DSM-III) were measured. Cognitive function was tested with the Mini-Mental State Exam. Other psychiatric symptoms were measured by the Comprehensive Psychopathological Rating Scale. RESULTS The one-year prevalence of any psychotic symptom was 7.4% (95% confidence interval [CI] 3.8-12.5); including hallucinations 6.7% (95% CI 3.4-11.8) and delusions 0.6% (95% CI 0.0-3.4). Four (2.4%) individuals fulfilled DSM-III-R criteria for schizophrenia. Individuals with psychotic symptoms or paranoid ideation did not differ regarding cognitive functioning compared with individuals without these symptoms. Individuals with hallucinations and paranoid ideation had an increased frequency of previous paranoid personality traits compared with individuals without psychotic symptoms and paranoid ideation. No individuals with psychotic symptoms had a formal thought disorder, incoherence of speech, or flat affect. CONCLUSION The authors found a high prevalence of psychotic symptoms, paranoid ideation, and schizophrenia in the very old. Most of the symptoms were elucidated by information from key informants, illustrating the importance of including relatives in the evaluation of elderly persons.
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Böwing G, Schmidt KUR, Juckel G, Schröder SG. [Psychosis in elderly post-traumatic stress disorder patients]. DER NERVENARZT 2007; 79:73-9. [PMID: 17962915 DOI: 10.1007/s00115-007-2359-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Late-onset post-traumatic stress disorder (PTSD) patients with traumatic experiences from World War II often present psychotic features. METHODS Twelve psychotic elderly PTSD patients were compared with 22 nonpsychotic elderly PTSD patients for age, marital status, age of traumatization, age of onset of psychiatric symptoms, and psychiatric comorbidities. The contents of delusions and hallucinations were registered as well as trauma details. RESULTS The psychotic PTSD patients were significantly older (80 years vs 74), later traumatized (20 years vs 14), more frequently demented (75% vs 27%), and more frequently widowed (83% vs 50%). The contents of their psychotic features often were related to traumatic experiences in early life. CONCLUSIONS Psychoses of traumatized elderly patients should be registered regarding psychotic content to discover a possible relation between traumatic experiences and psychosis. The International Classification of Diseases 11th Edition should include the subtype "PTSD with simultaneous psychotic features."
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Affiliation(s)
- G Böwing
- Klinik für Psychiatrie und Psychotherapie Röbel, MediClin Müritz-Klinikum GmbH, Stadtgarten 15, 17207, Röbel.
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Klug G, Hermann G, Fuchs-Nieder B, Stipacek A, Zapotoczky HG. Geriatric psychiatry home treatment (GHT): a pilot study on outcomes following hospital discharge for depressive and delusional patients. Arch Gerontol Geriatr 2007; 47:109-20. [PMID: 17945364 DOI: 10.1016/j.archger.2007.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 07/07/2007] [Accepted: 07/09/2007] [Indexed: 11/25/2022]
Abstract
Elderly people with mental health problems receive much worse outpatient care than younger people. Although the health-promoting factors are known, there are hardly any studies on effective biopsychosocial care models. A 1-year longitudinal study examined the effectiveness of the GHT presented below. For this purpose, 12 depressive and delusional patients discharged from inpatient gerontopsychiatric care received mental and social treatment and care at home for 1 year. Functionality was surveyed by means of the Global Assessment of Functioning Scale (GAF) and psychiatric symptoms by means of the Brief Psychiatric Rating Scale (BPRS). Subjective quality of life (QoL) was surveyed by means of the WHOQOL-BREF self-report questionnaire. The main findings were as follows: (1) no patient had to receive inpatient psychiatric care or be admitted to a nursing home during the study period; (2) mental QoL had improved significantly after 1 year; (3) functionality remained stable; (4) the BPRS scores did not deteriorate. We see this as confirmation that GHT is an effective instrument for extramural care of elderly people with psychiatric disorders. The limitations of the pilot study necessitate further studies to back up the findings.
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Affiliation(s)
- Günter Klug
- Association of Mental Health Development, Psychosocial Center Graz-East, Hasnerplatz 4, A-8010 Graz, Austria.
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Ostling S, Pálsson SP, Skoog I. The incidence of first-onset psychotic symptoms and paranoid ideation in a representative population sample followed from age 70-90 years. Relation to mortality and later development of dementia. Int J Geriatr Psychiatry 2007; 22:520-8. [PMID: 17117394 DOI: 10.1002/gps.1696] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Limited data are available on the incidence of psychotic symptoms in the elderly. OBJECTIVE To elucidate the incidence of first-onset psychotic symptoms in the elderly and their relation to mortality and later development of dementia. METHOD A population-sample (n = 392) born 1901-1902 was assessed from age 70-90 with psychiatric examinations, medical record reviews and from age 85, also with key-informant interviews. Individuals developing dementia were excluded. RESULT The cumulative incidence of first-onset psychotic symptoms was 4.8% (8.0% including key-informant reports in the total sample) and 19.8 % in those who survived to age 85. Sixty-four percent of those with first-onset hallucinations later developed dementia, compared to 30% of those with delusions and 25% of those without psychotic symptoms. CONCLUSIONS One fifth of non-demented elderly who survives up to age 85 develops first-onset psychotic symptoms. Hallucinations predict dementia, but most elderly individuals with first-onset psychotic symptoms do not develop dementia.
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Affiliation(s)
- S Ostling
- The Sahlgrenska Academy at Göteborg University, Institute of Clinical Neuroscience and Physiology, Psychiatry Section, Unit of Epidemiology, Sahlgrenska University Hospital, Göteborg, Sweden.
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Freeman D. Suspicious minds: The psychology of persecutory delusions. Clin Psychol Rev 2007; 27:425-57. [PMID: 17258852 DOI: 10.1016/j.cpr.2006.10.004] [Citation(s) in RCA: 488] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Accepted: 10/10/2006] [Indexed: 10/23/2022]
Abstract
At least 10-15% of the general population regularly experience paranoid thoughts and persecutory delusions are a frequent symptom of psychosis. Persecutory ideation is a key topic for study. In this article the empirical literature on psychological processes associated with persecutory thinking in clinical and non-clinical populations is comprehensively reviewed. There is a large direct affective contribution to the experience. In particular, anxiety affects the content, distress and persistence of paranoia. In the majority of cases paranoia does not serve a defensive function, but instead builds on interpersonal concerns conscious to the person. However, affect alone is not sufficient to produce paranoid experiences. There is also evidence that anomalous internal experiences may be important in leading to odd thought content and that a jumping to conclusions reasoning bias is present in individuals with persecutory delusions. Theory of mind functioning has received particular research attention recently but the findings do not support a specific association with paranoia. The threat anticipation cognitive model of persecutory delusions is presented, in which persecutory delusions are hypothesised to arise from an interaction of emotional processes, anomalous experiences and reasoning biases. Ten key future research questions are identified, including the need for researchers to consider factors important to the different dimensions of delusional experience.
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Affiliation(s)
- Daniel Freeman
- Department of Psychology, Institute of Psychiatry, King's College London, Denmark Hill, London, UK.
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Abstract
Delusions have long been considered a hallmark of psychotic disorders such as schizophrenia. However, delusions may only be most visibly present in psychotic conditions and could also occur in nonclinical groups. The aim of this review is to establish whether delusions, as traditionally considered and assessed in psychiatric conditions, are also present in individuals without a psychiatric or neurologic condition. Clear evidence is found that the rate of delusional beliefs in the general population is higher than the rate of psychotic disorders and that delusions occur in individuals without psychosis. The frequency of delusional beliefs in nonclinical populations varies according to the content of the delusion studied and the characteristics of the sample population. Approximately 1% to 3% of the nonclinical population have delusions of a level of severity comparable to clinical cases of psychosis. A further 5% to 6% of the nonclinical population have a delusion but not of such severity. Although less severe, these beliefs are associated with a range of social and emotional difficulties. A further 10% to 15% of the nonclinical population have fairly regular delusional ideation. There is convincing evidence that delusional ideation, delusions, and clinically severe delusions are related experiences. Information about clinical delusions can therefore be obtained by studying delusional ideation in nonclinical populations.
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Riedel-Heller SG, Busse A, Angermeyer MC. The state of mental health in old-age across the 'old' European Union-- a systematic review. Acta Psychiatr Scand 2006; 113:388-401. [PMID: 16603030 DOI: 10.1111/j.1600-0447.2005.00632.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The paper provides the first syllabus on the prevalence of mental disorders in old-age focusing on surveys conducted in the 15 countries, which comprised the 'old' European Union. METHOD A systematic search of the literature published from 1990 onwards was conducted. RESULTS Mental disorders in old-age are common. The most serious threats to mental health in old-age are posed by dementia and depression. It is a clear cut finding that dementia exponentially increases with age. The basic issue of whether depression increases or decreases with age remains unsolved. Databases on substance use, mild cognitive impairment, psychotic syndromes, anxiety, and somatoform disorders in old-age are much smaller, making conclusions difficult to draw. CONCLUSION Numerous questions in the field remain to be answered. Concerted action is needed to produce comparable data across Europe.
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Psychotic symptoms in the elderly. ACTA ACUST UNITED AC 2005. [DOI: 10.1007/bf02629403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
This article reviews the prevalence and incidence of mental disorders in older adults. The authors outline the epidemiologic challenges in determining the frequency of mental disorders in late-life and discuss issues that are critical for understanding the prevalence of the disorders and for reviewing the evidence from epidemiologic studies of mental disorders in this population. The authors summarize the epidemiologic data for depression, anxiety, dementia, schizophrenia, and alcoholism. Also included is a discussion of risk factors and outcomes of these disorders and a discussion of the implications of these epidemiologic findings for geriatric medicine.
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Affiliation(s)
- Celia F Hybels
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3003, Durham, NC 27710, USA.
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Mehta KM, Simonsick EM, Penninx BWJH, Schulz R, Rubin SM, Satterfield S, Yaffe K. Prevalence and correlates of anxiety symptoms in well-functioning older adults: findings from the health aging and body composition study. J Am Geriatr Soc 2003; 51:499-504. [PMID: 12657069 DOI: 10.1046/j.1532-5415.2003.51158.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the prevalence and correlates of anxiety symptoms in the absence of depression, in older black and white people. DESIGN Cross-sectional study. SETTING Baseline assessment of a biracial cohort of community-resident well-functioning men and women aged 70 to 79 participating in the Health Aging and Body Composition study. PARTICIPANTS Three thousand forty-one participants (mean age 74, 52% women, 58% white). MEASUREMENTS Participants were asked about three major anxiety symptoms (feeling fearful, tense/keyed-up, or shaky/nervous) derived from the Hopkins Symptom Checklist. Participants were considered to have anxiety symptoms if they reported feeling at least two anxiety symptoms "a little" or one symptom "quite a bit" in the past week. Logistic regression models were used to identify demographic, psychosocial, and health-related correlates of anxiety symptoms. RESULTS Anxiety symptoms occurred in 15% of older people without depression and 43% of those with depression. Of nondepressed older people, women were more likely to have anxiety symptoms than men (P <.01), especially white women (20% prevalence). After multivariate adjustment, the chronic conditions of urinary incontinence (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.1-1.9), hearing impairment (OR = 1.4, 95% CI = 1.0-2.1), hypertension (OR = 1.3, 95% CI = 1.0-1.7) and poor sleep (OR = 1.7, 95% CI = 1.3-2.4) were associated with a higher prevalence of anxiety symptoms. Persons with poorer psychosocial functioning, low personal mastery (OR = 2.0, 95% CI = 1.6-2.5) and the need for more emotional support (OR = 2.2, 95% CI = 1.7-2.8), also had higher rates of anxiety symptoms. CONCLUSION Anxiety symptoms are common in depressed and nondepressed older people. Given the high prevalence and coexistence with depressive symptoms, it will be important to conduct longitudinal studies that assess depressive and anxiety symptoms to clarify the direction and influence and disentangle the health-related consequences of these two conditions.
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Affiliation(s)
- Kala M Mehta
- Division of Geriatrics, University of California at San Francisco, San Francisco, California 94121,
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Hassett A. Schizophrenia and delusional disorders with onset in later life. BRAZILIAN JOURNAL OF PSYCHIATRY 2002. [DOI: 10.1590/s1516-44462002000500015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Schizophrenia-spectrum illness is most commonly associated with an onset in early adulthood. When non-affective psychotic symptoms emerge for the first time in later life, the clinical presentation has both similarities and differences with earlier-onset syndromes. This situation has resulted in continuing debate about the nosological status of late-onset psychosis, and whether there are particular risk factors associated with this late-life peak in incidence. Although early cognitive decline is frequently identified in these patients, studies, to date, have not established if there is a relationship with the dementing illnesses of old age. Sensory impairment, social isolation, and a family history of schizophrenia have been associated with late-onset psychosis, but appear to exert a nonspecific influence on vulnerability. While diagnostic issues remain unresolved, clinicians need to formulate treatment strategies that most appropriately address the constellation of symptoms in the clinical presentation of their psychotic elderly patients.
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Bazargan M, Bazargan S, King L. Paranoid ideation among elderly African American persons. THE GERONTOLOGIST 2001; 41:366-73. [PMID: 11405434 DOI: 10.1093/geront/41.3.366] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The prevalence and correlates of paranoid ideation were investigated. DESIGN AND METHODS On the basis of a sample of 998 independently living elderly African American persons in a cross-sectional study, the study used the Brief Symptom Inventory to measure paranoid ideation and 14 independent variables, including demographic characteristics, cognitive deficit, depression, self-reported memory functioning, emotional and instrumental support, stressful life events, limitation of daily activities, self-rated health status, and self-rated hearing and vision. RESULTS AND IMPLICATIONS Paranoid ideation (symptoms of paranoia) was found in 10% of this sample. A multiple regression analysis of the data revealed that of the 14 independent variables used in this study, 6 (income, instrumental support, hearing, stressful life events, self-reported memory deficit, and depression) showed a significant relationship with paranoid ideation.
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Affiliation(s)
- M Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine & Science, Los Angeles, CA 90059, USA.
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Livingston G, Kitchen G, Manela M, Katona C, Copeland J. Persecutory symptoms and perceptual disturbance in a community sample of older people: the Islington study. Int J Geriatr Psychiatry 2001; 16:462-8. [PMID: 11376461 DOI: 10.1002/gps.362] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND While there are extensive studies of paranoid symptoms and perceptual disturbance (PPD) in younger adults, relatively little is known about older adults with similar symptoms. METHOD This study took place in Islington, an inner London borough. Enumeration Districts were randomised to provide a sampling frame. Residents aged 65 or over were interviewed at home. The Short-CARE was used to elicit psychiatric symptoms and diagnosis. Sociodemographic particulars were elicited using the Client Sociodemographic and Service Receipt Inventory. Questions were asked regarding sight and hearing. We used subsections of the geriatric mental scale to identify people who had PPD symptoms. Medications taken were recorded. We asked 'Do you have any health problems?' as a screening question for subjective health problems. RESULTS We interviewed 720 people. Twenty-eight (3.9%) participants scored positively on the PPD sub-scales of the GMS. A forward logistic regression analysis for independent predictors of PPD found the significant independent predictors were dementia (p = 0.0000; odds ratio 6.8), drinking alcohol in last 6 months (p < 0.03; odds ratio 0.3), drinking alcohol to help sleep (p < 0.005; odds ratio 9.6), subjective memory loss (p < 0.007; odds ratio 3.3) and uncorrected visual impairment (p < 0.02; odds ratio 2.8). CONCLUSION There is a relatively high prevalence of PPD in older people living in the community. This is not associated with higher use of services despite the increased needs. Further studies should consider interventions to meet this unmet need.
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Affiliation(s)
- G Livingston
- Senior Lecturer in Psychiatry, Royal Free and University College Medical School, Department of Psychiatry and Behavioural Sciences, London, UK.
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