Enid Rockwell

Lower Incidence of Tardive Dyskinesia with Risperidone Compared with Haloperidol in Older Patients

OBJECTIVE: To compare the 9‐month cumulative incidence of tardive dyskinesia (TD) with risperidone to that with haloperidol in older patients.

Conventional vs. Newer Antipsychotics in Elderly Patients

Elderly patients with schizophrenia and dementia patients with agitation are frequently candidates for antipsychotic treatment. Conventional neuroleptics have relatively little effect on negative symptoms and may cause considerable side effects, especially in elderly patients. The authors have found a 29% cumulative annual incidence of tardive dyskinesia (TD) in middle-aged and elderly outpatients treated with relatively low doses of conventional neuroleptics Newer antipsychotics are less likely to cause extrapyramidal symptoms and may be associated with a lower risk of TD. They are generally effective for both positive and negative symptoms and may also improve some aspects of cognition, but these drugs have their own side effects. Dosing requirements for elderly patients tend to be much lower than those for younger adults.

Psychotic symptoms in Parkinson's disease patients with dementia

OBJECTIVE: To assess the prevalence of psychotic symptoms in a group of patients with Parkinsons disease (PD) and dementia and examine the association of psychotic symptoms with neuropsychiatric problems, the level of distress reported by caregivers, and cognitive and functional impairment.

Anxiety, depression and disability across the lifespan

The authors examined the relationship between anxiety, depression and physical disability, after controlling for demographic and health variables, in a sample of 374 adults aged 18–94. Results indicate that anxiety, depression and comorbid anxiety and depression are associated with higher levels of disability, after controlling for factors such as age, gender, income, self-rated health, number of medical conditions and number of physician visits in the past year. Furthermore, anxiety, depression and comorbid anxiety and depression have a differential effect on disability according to age, with older adults with any of these symptoms reporting higher levels of disability than younger adults. These findings suggest that physicians working with older adults should assess for and treat anxiety as well as depressive symptoms.

Adverse neurobiological effects of long-term use of neuroleptics: human and animal studies.

Neuroleptics have revolutionized the treatment of schizophrenia and other psychoses since the early 1950s. Several adverse neurobiological effects are, however, associated with the long-term use of these agents. This article will review human and animal studies of these adverse effects, and also present some new data. Tardive dyskinesia (TD) is the most widely studied potentially persistent movement disorder resulting from long-term neuroleptic treatment, and several risk factors for TD development have been identified. Although drug-induced parkinsonism (DIP) usually disappears after the offending agent is withdrawn, a small portion of patients may have persistent parkinsonism. It is however, unclear if this is an aging-related effect. Persistent cognitive impairment associated with long-term use of typical neuroleptics has not been well documented. Atypical antipsychotics may produce improvement in cognitive performance in patients with chronic schizophrenia. MRI changes that are secondary to neuroleptics are possible, but have not yet been studied adequately. There is one unconfirmed report of neurofibrillary tangles associated with long-term neuroleptic use. A number of investigators have reported vacuous chewing movements, and neuropathologic changes following prolonged administration of neuroleptics in animals. We discuss the implications of the various reported adverse effects of long-term use of neuroleptics.

Extrapyramidal Side Effects in Patients With Alzheimer's Disease Treated With Low-Dose Neuroleptic Medication

The authors examined whether the presence of extrapyramidal side effects (EPS), measured before neuroleptic treatment was initiated, could be used to predict the development and severity of neuroleptic-induced parkinsonism (NIP) in Alzheimers disease (AD). Twenty-four newly medicated probable AD patients were assessed with a battery of measures of extrapyramidal motor function. Assessments were made before neuroleptic therapy, and 3 and 9 months after treatment. Posttreatment clinical findings revealed that 66.7% of the AD patients developed NIP. Patients who developed NIP exhibited more severe pretreatment bradykinesia on instrument-derived measures. These findings suggest that a substantial proportion of AD patients treated with neuroleptics develop significant EPS and that the risk for EPS can be estimated before intervention by use of instruments measuring motor function.

A Study of Delusions in a Large Cohort of Alzheimer's Disease Patients

The authors analyzed data on delusions and associated neuropsychiatric symptoms in 1,229 consecutive patients with Alzheimers disease (AD) at nine university-based State of California Alzheimers Disease Diagnostic and Treatment Centers. Thirty-four percent of these patients had delusions. The delusional patients were older, more likely to be female, and had a later onset of AD than the nondelusional group. Compared to the nondelusional patients, the delusional patients also had more severe global cognitive impairment, along with a higher prevalence of hallucinations, agitation, depression, and gait disturbance, as well as family and marital difficulties and self-care problems.

Older adults are less accurate than younger adults at identifying symptoms of anxiety and depression.

The present study examined age differences in the identification of anxiety and depressive symptoms in a community sample of 374 adults, ages 18 to 93. Older adults were less accurate and more likely than younger adults to label symptoms as neither anxiety nor depression. Both older and younger adults were more accurate in their classification of depressive than anxiety symptoms. These findings suggest that additional efforts are needed to educate the general public, particularly older adults, about anxiety and its symptoms.

Psychopathology at initial diagnosis in dementia with Lewy bodies versus Alzheimer disease: comparison of matched groups with autopsy-confirmed diagnoses.

Dementia with Lewy bodies (DLB) is believed to be the second most common form of dementia, after Alzheimer disease (AD). DLB has been reported to be associated with an increase in psychopathology; however, antemortem diagnosis of DLB cannot always be made with certainty. We searched the database of University of California, San Diego SOCARE (Seniors Only Care) outpatient program. There were 26 autopsy‐confirmed cases of DLB. We matched them individually with 26 autopsy‐confirmed cases of ‘pure’ AD on gender, ethnicity, and Mini‐Mental State Examination score at the baseline evaluation. We compared the two groups on psychopathologic measures and possible risk factors for psychopathology based on the data obtained at the time of the initial diagnosis of dementia. Five psychiatric symptoms: hallucinations, delusions, anxiety, anhedonia, and loss of energy were significantly more common in DLB patients than in AD patients. DLB patients were younger at initial evaluation and death as compared to AD patients, but there was no difference in age of onset of dementia, level of education, or family or past history of any major neuropsychiatric disorder, prescription of psychotropic medications, or sensory impairment. Psychiatric symptoms were more common at time of initial diagnosis of dementia in DLB than in AD patients. This difference could not be attributed to any known risk factors for psychopathology examined. Psychopathology should be considered an integral part of DLB, and should be taken into account in the initial diagnosis of the type of dementia. Copyright

Late-onset psychosis with somatic delusions.

The authors studied 10 patients who had late-onset psychosis with somatic delusions and 2 comparison groups similar in age and education: 9 late-onset psychosis patients without somatic delusions and 10 normal control subjects. Demographic, clinical, and neuropsychological data were obtained. Brain magnetic resonance imaging was also done and compared. The patients with somatic delusions were somewhat more likely to be women, have been ill longer, and meet DSM-III-R criteria for delusional disorder, compared with late-onset psychotic patients without somatic delusions. Patients with somatic delusions also had lower scores on a full-scale IQ test, compared with the normal comparison subjects. The patients with somatic delusions rarely benefitted from and poorly complied with treatment with psychotropics. The studys limitations, such as small sample size and heterogeneity of diagnosis, as well as the possible clinical implications of these findings are also discussed.