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Psychosis in elderly

Brianna L Combs, Arthur G Cox
Parkinson's disease (PD) has a prevalence of nearly 1 million people in the USA, with increasing incidence in the elderly population. Generally, the age of presentation is between 55 and 65 years, with the likelihood of diagnosis increasing as patients reach the age of 80 years or above. Some of the common treatments for PD increase dopamine levels in the brain. Dopaminergic therapy helps to improve motor and non-motor symptoms, but it is not without risks. Dopaminergic therapy can cause confusion, delirium, and psychotic-like behavior...
2017: Neuropsychiatric Disease and Treatment
Ciro Manzo, Pietro Gareri, Alberto Castagna
We describe the case of an elderly woman with elderly-onset rheumatoid arthritis, where the use of 4 mg/kg/day of hydroxychloroquine (HCQ) was followed by the onset of psychomotor agitation with marked physical and verbal violence towards her partner, including throwing objects at her partner. No disturbance in sleep and no anxiety, nervousness, or irritability had emerged before the onset of her psychomotor agitation. The disappearance of agitation following targeted pharmacologic intervention and HCQ interruption, its re-onset after reintroduction of the drug, and the high score (9) of Naranjo's algorithm are surely linked to the existence of a causal relationship between HCQ and psychomotor agitation...
December 2017: Drug Safety—Case Reports
Johan Zelano, Elinor Ben-Menachem
Epileptic emergencies are frequently encountered and include ictal events as status epilepticus or seizure clusters, and non-ictal situations like postictal psychosis or acute drug side effects. The aim of this review was to describe recent pharmacological advances in the treatment of epileptic emergencies. Areas covered: Based on clinically relevant questions, a literature search was performed. The search showed that most pharmacological advances have been made in management of status epilepticus, where substantial literature has accumulated on several AEDs with potentially less side-effects than the traditional choices...
October 14, 2016: Expert Opinion on Pharmacotherapy
Maksim A Shlykov, Swapnil Rath, Alison Badger, Gerald Scott Winder
We present the case of an elderly woman with hypothyroidism and no psychiatric history who presented with new onset of psychosis, paranoia, catatonic features and Capgras syndrome (CS). This case illustrates the spectrum of neuropsychiatric symptoms that may accompany hypothyroidism and the importance of considering thyroid dysfunction as a primary contributor to severe psychiatric symptoms, especially in previously stable patients. We demonstrate the effectiveness of combination levothyroxine and olanzapine, with its favourable cardiac profile, in the treatment of myxoedema madness...
September 9, 2016: BMJ Case Reports
Eric C Sun, Beth D Darnall, Laurence C Baker, Sean Mackey
IMPORTANCE: Chronic opioid use imposes a substantial burden in terms of morbidity and economic costs. Whether opioid-naive patients undergoing surgery are at increased risk for chronic opioid use is unknown, as are the potential risk factors for chronic opioid use following surgery. OBJECTIVE: To characterize the risk of chronic opioid use among opioid-naive patients following 1 of 11 surgical procedures compared with nonsurgical patients. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of administrative health claims to determine the association between chronic opioid use and surgery among privately insured patients between January 1, 2001, and December 31, 2013...
September 1, 2016: JAMA Internal Medicine
Ravishankar Jayadevappa, Sumedha Chhatre
OBJECTIVE: To analyze the association between age, substance use, and outcomes in fee-for-service Medicare enrollees with advanced prostate cancer. METHODS: Retrospective longitudinal cohort study of elderly men diagnosed with advanced prostate cancer using SEER-Medicare data between 2000 and 2009. Substance use disorder was identified using claims for alcoholic psychosis, drug psychoses, alcohol dependence syndrome, drug dependence, and non-dependent use of drugs...
November 2016: Journal of Geriatric Oncology
Vitalii V Cozac, Michael M Ehrensperger, Ute Gschwandtner, Florian Hatz, Antonia Meyer, Andreas U Monsch, Michael Schuepbach, Ethan Taub, Peter Fuhr
OBJECTIVE: To investigate the incidence of serious adverse events (SAE) of subthalamic deep brain stimulation (STN-DBS) in elderly patients with Parkinson's disease (PD). METHODS: We investigated a group of 26 patients with PD who underwent STN-DBS at mean age 63.2 ± 3.3 years. The operated patients from the EARLYSTIM study (mean age 52.9 ± 6.6) were used as a comparison group. Incidences of SAE were compared between these groups. RESULTS: A higher incidence of psychosis and hallucinations was found in these elderly patients compared to the younger patients in the EARLYSTIM study (p < 0...
2016: Frontiers in Aging Neuroscience
Camilla Callegari, M Ielmini, L Bianchi, M Lucano, Lorenza Bertù, Simone Vender
The authors set out to examine qualitatively the use of antiepileptic drugs (AEDs) in a population of older adults in a nursing home setting, evaluating aspects such as specialist prescriptions and changes in dosage. This retrospective prevalence study was carried out in a state-funded nursing home that provides care and rehabilitation for elderly people. The first objective of the study was to determine the prevalence of AED use in this population. The second objective was to monitor AED dosage modifications during the fifteen-month study period, focusing on the safety and the tolerability of AEDs...
April 2016: Functional Neurology
Sheldon H Preskorn, Matthew Macaluso
This series of columns has 3 main goals: (1) to explain class warnings as used by the United States Food and Drug Administration, (2) to increase awareness of movement disorders that may occur in patients treated with antipsychotic medications, and (3) to understand why clinicians should refrain from immediately assuming a diagnosis of tardive dyskinesia/dystonia (TD) in patients who develop abnormal movements during treatment with antipsychotics. The first column in the series presented a patient who developed abnormal movements while being treated with aripiprazole as an augmentation strategy for major depressive disorder (MDD) and reviewed data concerning the historical background, incidence, prevalence, and risk factors for tardive and spontaneous dyskinesias, the clinical presentations of which closely resemble each other...
March 2016: Journal of Psychiatric Practice
Jacob Ninan, Gemy Maria George
BACKGROUND: Elderly patients, in particular, have been reported to develop psychiatric side effects from antibiotics. Clarithromycin, quinolones, sulfamethoxazole-trimethoprim, isoniazid, penicillin, and cephalosporins have been reported to cause psychosis. This case report bridges a void in the medical literature with regards to the psychiatric adverse effects of imipenem-cilastatin. CASE PRESENTATION: A 64-year-old Hispanic man in septic shock due to urinary tract infection was initiated on imipenem-cilastatin and mechanically ventilated, following admission to hospital...
April 27, 2016: Journal of Medical Case Reports
Wei-Juan Xu, Ning Wei, Yi Xu, Shao-Hua Hu
BACKGROUND: Over-the-counter cold medicines, which contain amantadine, are widely used in the People's Republic of China. Clinicians are familiar with the psychosis caused by long-term treatment with amantadine, especially in elderly patients; however, early-onset psychotic complications among healthy young individuals have rarely been reported. CASE PRESENTATION: This article reports the case of a 28-year-old patient who presented with hallucination-delusion syndrome soon after treatment with cold medicine containing amantadine hydrochloride and acetaminophen...
2016: Neuropsychiatric Disease and Treatment
Murielle Girard, Philippe Nubukpo, Dominique Malauzat
BACKGROUND: The role of information and communications technology is becoming increasingly prevalent in daily life and in the organization of medical care: are some people being left out? AIMS: To evaluate access to and the uses of communication resources by psychiatric patients, focusing on the means of communication (e.g. mobile phones and computers), access and frequency of internet use. METHODS: A questionnaire was distributed, over a period of 1 week, to inpatients or day hospitalised patients aged over 12 years in all care units...
February 2017: Journal of Mental Health
Anna Partyka, Anna Wasik, Magdalena Jastrzębska-Więsek, Paweł Mierzejewski, Przemysław Bieńkowski, Marcin Kołaczkowski, Anna Wesołowska
Behavioral and psychological symptoms of dementia (BPSD) include apathy, sleep problems, irritability, wandering, elation, agitation/aggression, and mood disorders such as depression and/or anxiety. Elderly patients are usually treated with second-generation antipsychotics; however, they present not enough efficacy against all symptoms observed. Hence, there still is an unmet need for novel pharmacotherapeutic agents targeted BPSD. A novel arylsulfonamide derivative ADN-1184 has been developed that possesses a preclinical profile of activity corresponding to criteria required for treatment of both psychosis and depressive symptoms of BPSD without exacerbating cognitive impairment or inducing motor disturbances...
June 2016: Naunyn-Schmiedeberg's Archives of Pharmacology
Letizia Polito, Tino Emanuele Poloni, Roberta Vaccaro, Simona Abbondanza, Michela Mangieri, Annalisa Davin, Simona Villani, Antonio Guaita
High total homocysteine (tHcy) is associated with cognitive impairment in the elderly. The impact of high tHcy on different cognitive domains deserves further investigation, as does the role of the C677T polymorphism of the 5,10 methylenetetrahydrofolate reductase (MTHFR) gene. A cross-sectional analysis of 903 subjects from the population-based "InveCe.Ab" study was performed. The participants had no psychosis or active neurological disorders. They underwent a neuropsychological assessment. Principal component analysis allowed cognitive performance to be condensed into two components: executive functions and memory...
April 2016: Experimental Gerontology
N S Hunter, K C Anderson, A Cox
Pimavanserin (ACP-103) is a selective inverse agonist of the 5-hydroxytryptamine 2A (5-HT2A) receptor intended to treat patients with Parkinson's disease psychosis (PDP). Currently there are no FDA-approved medications in the United States for the treatment of PDP, although on September 2, 2014, the United States Food and Drug Administration granted breakthrough therapy status to pimavanserin, highlighting the unmet need for therapeutics in this class. Most antipsychotic medications worsen motor dysfunction due to dopamine antagonism, and all carry a black box warning for an increased risk of mortality in elderly patients with dementia-related psychosis...
November 2015: Drugs of Today
Adam J Karz, Daniel P McGonigle, Joseph F Goldberg, Charles H Kellner, Brandon S Calenda
The use of neuroleptics in the elderly has been a topic of debate since 2005 when the US Food and Drug Administration issued a black-box warning of increased risk of mortality in elderly patients with dementia-related psychosis. Antipsychotic alternatives such as divalproex are sometimes favored on an "off-label" basis to manage agitation in the demented elderly, and antipsychotic use is often clinically necessary to treat psychosis in older adults, with or without dementia. Concurrently, risk for iatrogenic corrected QT (QTc) prolongation on electrocardiogram (ECG) remains a concern with the use of many antipsychotic agents because of its associated potential for fatal arrhythmias...
December 2015: Journal of Clinical Psychiatry
Chaobiao Xue, Shaoxian Chen, Qi Lin, Houshi Zhou, Chuming Huang, Jiyuan Lin, Weihang Xie, Kai Chen, Dongming Zhou, Wan Ma, Feiyu Ma, Haiyun Xu
Herpes simplex encephalitis is a rare disease. In adults, most of the reported cytomegalovirus (CMV) infections are seen in immunocompromised patients. We present a case of 67-year-old Chinese male with the coinfection of CMV and herpes simplex virus type II (HSV-II). He had no history of being treated with immunosuppressants, showed symptoms of psychosis and was scored 109 on the Positive and Negative Syndrome Scale. This patient presented with a rare case of coinfection of CMV and herpes simplex virus type II with psychotic symptoms...
2015: Neuropsychiatric Disease and Treatment
Shinichi Ueno, Satoko Tsuboi, Motoki Fujimaki, Hiroto Eguchi, Yutaka Machida, Nobutaka Hattori, Hideto Miwa
INTRODUCTION: Hypothyroidism is one of the most important causes of treatable dementia, and psychosis occasionally associated with it is known as myxedema madness. We report a case of a 90-year-old patient who developed myxedema madness acutely without overt clinical symptoms and signs suggestive of hypothyroidism. CASE PRESENTATION: A 90-year-old Japanese man, a general practitioner, was admitted to our emergency room because of acute-onset lethargy, delusions, and hallucinations...
November 17, 2015: Journal of Medical Case Reports
Savya Cybelle Milhomem Rocha, Marcia Akemi Kii, Cristiana Borges Pereira, Danilo Totarelli Borelli, Orestes Forlenza, Tanit Ganz Sanchez
BACKGROUND: Although auditory hallucinations are considered a psychopathological phenomenon, musical hallucinations have been reported in individuals without psychosis but with auditory symptoms (tinnitus and/or hearing loss). Thus, a possible different cognitive functioning may be involved in musical hallucinations. The aim of the study was to characterize patients with tinnitus and musical hallucinations through a multidisciplinary assessment, allowing a better understanding of these concomitant phenomena...
2015: Psychopathology
Tiina Talaslahti, Hanna-Mari Alanen, Helinä Hakko, Matti Isohanni, Olli Kampman, Unto Häkkinen, Esa Leinonen
OBJECTIVE: In this register-based study the rates and durations of psychiatric hospitalizations were compared between patients with very-late-onset schizophrenia-like psychosis (VLOSLP, n = 918) and elderly patients with illness onset before 60 years (n = 6142). The proportion of patients ending up in long-term care (LTC) or long-lasting psychiatric hospital care (LLP) was also studied. METHODS: A sample of patients with schizophrenia aged 65 or over was collected from the Finnish Hospital Discharge Register...
April 2016: International Journal of Geriatric Psychiatry
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