The degree of concomitant AD tangle pathology has an important influence on the clinical characteristics and, therefore, the clinical diagnostic accuracy of DLB.
Neuroleptic-induced tardive dyskinesia (TD) continues to be a serious problem in the psychopharmacology of schizophrenia. The overall mean prevalence of TD among chronically neuroleptic-treated patients is approximately 24 percent. The annual incidence in younger adults is 4 to 5 percent. Aging is a major risk factor for TD. Our ongoing prospective study suggests that the annual incidence in patients over age 45 is over 30 percent. Other likely risk factors include female gender, mood disorders, "organic" brain dysfunction or damage, diabetes mellitus, and early extrapyramidal side effects. Metoclopramide, a D2-receptor blocker commonly used in non-psychiatric medical patients, can also produce persistent TD. TD can best be assessed for research purposes by a combination of subjective and objective methods. In recent years, several instrumental procedures have been developed to objectively quantify various abnormal movements. The advantages and limitations of the traditional rating scales and the newer instrumental approaches are discussed. The course of TD is variable but often not progressive. The early theory that striatal dopamine receptor supersensitivity causes TD has now given way to the hypothesis of multiple neurotransmitter system involvement. Several animal studies have reported striatal neuronal damage with prolonged neuroleptic treatment, although its relevance to TD remains unclear. Treatments for TD, other than neuroleptic withdrawal, are still experimental.
The authors evaluated 14 middle-aged and elderly patients with delusional disorder (DD) and 253 patients with schizophrenia (SC); all patients met DSM-III-R criteria. Because the DD patients were older and had a later age at onset of illness, a sub-sample of 50 SC patients with illness onset after age 40 was compared with the 14 DD patients on clinical and neuropsychological characteristics. The DD group had a less frequent history of past hospitalization but more severe overall psychopathologic symptoms. Level of neuropsychological impairment seemed somewhat lower in the DD group, but differences were nonsignificant because of small sample size. Diagnoses remained stable during up to 8 years' follow-up (average 4 years). These preliminary findings provide partial support to the clinical categorization of DD as a disorder distinct from SC.
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