A Perspective on Psychosis in Late Life and Deficits in Social Cognition

Abstract

The etiology of new psychotic symptoms in late life, including subtle changes in cognition, is a controversial emerging area of study. The development of psychotic symptoms, particularly paranoia, is a common occurrence in late life, and the symptoms of cognitive dysfunction and psychosis are often prominent in dementia, schizophrenia, and mood disorders. This intermixing of symptoms has inescapably led to diagnostic confusion with regard to elderly patients with new-onset psychosis. The complex relationship among different domains of psychopathology makes it difficult to tease apart disorders of affect from psychosis, affect from cognition, and psychosis from cognition. It is therefore potentially useful to modify and expand our approach to how we conceptualize these patients. Emerging evidence suggests that those with dementia, psychotic disorders, and mood disorders suffer from growing cognitive deficits. The article suggests that deficits in social cognition, in particular, may be the unifying deficit that helps to explain why heterogeneous patients may develop paranoia and psychotic symptoms in late life.

Social Cognitive Role of Schizophrenia Candidate Gene GABRB2

“…It has been associated also with impaired cognitive function [17] as well as social cognition [18], [19]. In biological terms, over-activity of the mesolimbic dopamine pathway has been suggested as a contributor to the positive symptoms of psychosis including delusions and hallucinations; a number of genes in the dopamine pathway including COMT [20] and DTNBP1 [21] showed association with risk of psychosis.…”

Terminology and assessment tools of psychosis: A systematic narrative review

“…Others only directly referred to delusions or hallucinations . Thought disorder, paranoia, illusions, ideas of reference, misidentification, disorganization, bizarre or disorganized behavior, psychomotor disorder, behavioral changes, and depersonalization and derealization were also included.…”

“…[195][196][197][198] Others only directly referred to delusions 199,200 or hallucinations. 201 Thought disorder, 97,131,145,156,161,165,167,169,184,189,[192][193][194]196,197,202 paranoia, 100,109,144,167,203 illusions, 100,144,168 ideas of reference, 118 misidentification, 122,134,157 disorganization, 123 bizarre or disorganized behavior, 156,161,165,184,185,189,191,193 psychomotor disorder, 165,184,193 behavioral changes, 159 and depersonalization and derealization 160 were also included.…”