Psychiatric hospital admission and long-term care in patients with very-late-onset schizophrenia-like psychosis

Talaslahti, Tiina; Alanen, Hanna-Mari; Hakko, Helinä; Isohanni, Matti; Kampman, Olli; Häkkinen, Unto; Leìnonen, Esa

doi:10.1002/gps.4333

Cited by 6 publications

(3 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A study of 918 patients with very late‐onset schizophrenia‐like psychosis, found that these patients needed more psychiatric hospitalisations than patients with earlier onset, but only in the first year after diagnosis, and the difference was rather small (14% and 11%, respectively). Rehospitalisation data are not presented in this study 23 . In our study, the mean age of onset of psychotic disorders was 8 years younger in the rehospitalised group compared to the group that was not rehospitalised, and this was the only variable that approached a statistical trend ( P = .12).…”

Section: Discussioncontrasting

confidence: 51%

Predicting rehospitalisation in older inpatients with a psychotic disorder

Kist

Berg

Kok

2020

Int J Geriat Psychiatry

View full text Add to dashboard Cite

Objective The objective of this study was to predict rehospitalisation in a psychiatric clinic in older inpatients with a psychotic disorder. Methods/Design In this prospective, observational study, all eligible inpatients aged 55 years and over with a primary psychotic disorder, admitted to a specialised ward for older psychotic patients in a large psychiatric inpatient clinic in the Netherlands, were asked to participate. Whether or not patients were rehospitalised and time to rehospitalisation were assessed 1 year after discharge from the ward. We recorded age, gender, living arrangement, psychiatric diagnosis, severity of psychotic symptoms, duration of index episode, age of onset of psychotic disorder, number of previous admissions, involuntary admission and use of depot medication at discharge. All patients underwent a neuropsychological assessment. Results Of the 90 patients that were included, 32 (35.6%) had been readmitted within 1 year after discharge. None of the demographic or clinical variables predicted rehospitalisation or the time to rehospitalisation. Conclusion Factors that predict rehospitalisationin younger adult patients with schizophrenia may not predict rehospitalisationin older patients with a psychotic disorder, of which the majority suffered from schizophrenia. We expect that other factors than those investigated may be of greater importance to predict rehospitalisation, as for example social support and coping mechanisms.

show abstract

Section: Discussioncontrasting

confidence: 51%

Predicting rehospitalisation in older inpatients with a psychotic disorder

Kist

Berg

Kok

2020

Int J Geriat Psychiatry

View full text Add to dashboard Cite

show abstract

“… 2 , 3 , 4 , 5 Older people with very late-onset schizophrenia-like psychosis present with positive psychosis symptoms, typically persecutory delusions with or without multimodal hallucinations, which are distressing, persist for many years, and are associated with increased risks of social dysfunction, institutionalisation, and death. 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

Antipsychotic treatment of very late-onset schizophrenia-like psychosis (ATLAS): a randomised, controlled, double-blind trial

Howard

Cort

Bradley

et al. 2018

The Lancet Psychiatry

View full text Add to dashboard Cite

SummaryBackgroundVery late (aged ≥60 years) onset schizophrenia-like psychosis occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy and risks of antipsychotic treatment. We investigated whether low-dose amisulpride (100 mg daily) is superior to placebo in reducing psychosis symptoms over 12 weeks and whether any benefit is maintained by continuing treatment after 12 weeks.MethodsThe ATLAS double-blind controlled trial enrolled participants from 25 old age psychiatry services in the UK. Eligible participants (ie, those with a diagnosis of very late-onset schizophrenia-like psychosis and a Brief Psychiatric Rating Scale [BPRS] score of ≥30, without cognitive impairment) were randomly assigned (1:1:1) to one of three groups in a two-stage trial: amisulpride in stage 1 and 2 (group A), amisulpride then placebo (group B), or placebo then amisulpride (group C). Treatment (100 mg oral amisulpride daily vs placebo) was given for 12 weeks in stage 1 and, initially, 24 weeks then reduced to 12 weeks in stage 2. Participants, investigators, and outcome assessors were masked to treatment allocation. Primary outcomes were psychosis symptoms assessed by the BPRS at 4, 12, and 24, or 36 weeks, and trial treatment discontinuation for non-efficacy. The primary, secondary, and safety endpoints were all analysed in participants given at least one dose of study treatment in modified intention-to-treat analyses. This study is registered with EudraCT, number 2010-022184-35, and ISRCTN, number ISRCTN45593573.FindingsBetween Sept 27, 2012, and June 28, 2016, we recruited 101 participants. 92 (91%) of 101 participants took trial medication, of whom 59 (64%) completed stage 1 and 34 (58%) of these 59 participants completed stage 2 treatment. Despite suboptimal compliance, improvements in BPRS scores at 12 weeks were 7·7 points (95% CI 3·8–11·5, p=0·0002) greater with amisulpride (mean 11·9 points [SE 1·3]) than with placebo (4·2 points [1·0]). In stage 2, BPRS scores improved by a mean of 1·1 points (1·6) from 12 weeks to the final assessment in those who continued amisulpride but deteriorated by 5·2 points (2·0) in those who switched from amisulpride to placebo (difference 6·3 points [95% CI 0·9–11·7], p=0·024). Fewer participants who were allocated amisulpride than placebo stopped treatment because of non-efficacy in stage 1 (p=0·010) and stage 2 (p=0·031). Serious adverse events were reported more frequently in the amisulpride group than in the placebo group in stage 1 (p=0·057) and stage 2 (p=0·19). The most common serious adverse events were infection (five patients in the amisulpride group, three in the placebo group) and extrapyramidal side-effects (three patients in the amisulpride group, none in the placebo group). Five patients died during the study, one from a gastric ulcer bleed before treatment started (group B), two while taking stage 2 treatment (one in group A and one in group C), and two who stopped trial treatment in stage 1 and died many weeks later (one in group B and one in group C...

show abstract

“…Comparisons of outcomes with patients with more typical early adult-onset schizophrenia who have grown old have indicated important differences. Although VLOSLP patients are more likely to be admitted to a psychiatric hospital than comparably aged patients with onset < 60 years, they are not more likely to transition to long-term residential care 58 and have better social functioning as indexed by participation, network size and availability of confidantes. 59 Differences in standardised mortality ratios between VLOSLP (5.02) and early schizophrenia (2.93) are largely explained by increased physical comorbidity and accidents in VLOSLP patients.…”

Section: Treatmentmentioning

confidence: 98%

Amisulpride for very late-onset schizophrenia-like psychosis: the ATLAS three-arm RCT

Howard

Cort

Bradley

et al. 2018

Health Technol Assess

View full text Add to dashboard Cite

Background Very late-onset (aged ≥ 60 years) schizophrenia-like psychosis (VLOSLP) occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy or risks of antipsychotic treatment. Most patients are not prescribed treatment. Objectives The study investigated whether or not low-dose amisulpride is superior to placebo in reducing psychosis symptoms over 12 weeks and if any benefit is maintained by continuing treatment thereafter. Treatment safety and cost-effectiveness were also investigated. Design Three-arm, parallel-group, placebo-controlled, double-blind, randomised controlled trial. Participants who received at least one dose of study treatment were included in the intention-to-treat analyses. Setting Secondary care specialist old age psychiatry services in 25 NHS mental health trusts in England and Scotland. Participants Patients meeting diagnostic criteria for VLOSLP and scoring > 30 points on the Brief Psychiatric Rating Scale (BPRS). Intervention Participants were randomly assigned to three arms in a two-stage trial: (1) 100 mg of amisulpride in both stages, (2) amisulpride then placebo and (3) placebo then amisulpride. Treatment duration was 12 weeks in stage 1 and 24 weeks (later reduced to 12) in stage 2. Participants, investigators and outcome assessors were blind to treatment allocation. Main outcome measures Primary outcomes were psychosis symptoms assessed by the BPRS and trial treatment discontinuation for non-efficacy. Secondary outcomes were extrapyramidal symptoms measured with the Simpson–Angus Scale, quality of life measured with the World Health Organization’s quality-of-life scale, and cost-effectiveness measured with NHS, social care and carer work loss costs and EuroQol-5 Dimensions. Results A total of 101 participants were randomised. Ninety-two (91%) participants took the trial medication, 59 (64%) completed stage 1 and 33 (56%) completed stage 2 treatment. Despite suboptimal compliance, improvements in BPRS scores at 12 weeks were 7.7 points (95% CI 3.8 to 11.5 points) greater with amisulpride than with placebo (11.9 vs. 4.2 points; p = 0.0002). In stage 2, BPRS scores improved by 1.1 point in those who continued with amisulpride but deteriorated by 5.2 points in those who switched from amisulpride to placebo, a difference of 6.3 points (95% CI 0.9 to 11.7 points; p = 0.024). Fewer participants allocated to the amisulpride group stopped treatment because of non-efficacy in stages 1 (p = 0.01) and 2 (p = 0.031). The number of patients stopping because of extrapyramidal symptoms and other side effects did not differ significantly between groups. Amisulpride treatment in the base-case analyses was associated with non-significant reductions in combined NHS, social care and unpaid carer costs and non-significant reductions in quality-adjusted life-years (QALYs) in both stages. Including patients who were intensive users of inpatient services in sensitivity analyses did not change the QALY result but resulted in placebo dominance in stage 1 and significant reductions in NHS/social care (95% CI –£8923 to –£122) and societal costs (95% CI –£8985 to –£153) for those continuing with amisulpride. Limitations The original recruitment target of 300 participants was not achieved and compliance with trial medication was highly variable. Conclusions Low-dose amisulpride is effective and well tolerated as a treatment for VLOSLP, with benefits maintained by prolonging treatment. Potential adverse events include clinically significant extrapyramidal symptoms and falls. Future work Trials should examine the longer-term effectiveness and safety of antipsychotic treatment in this patient group, and assess interventions to improve their appreciation of potential benefits of antipsychotic treatment and compliance with prescribed medication. Trial registration Current Controlled Trials ISRCTN45593573 and EudraCT2010-022184-35. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 67. See the NIHR Journals Library website for further project information.

show abstract

Psychiatric hospital admission and long-term care in patients with very-late-onset schizophrenia-like psychosis

Abstract: The patients with VLOSLP needed more psychiatric hospital care than those with earlier illness onset. Ending up in LTC/LLP was equally common in both onset groups, but some physical diseases, such as cardiovascular and respiratory, diminished the likelihood of this.

Cited by 6 publications

References 31 publications

Predicting rehospitalisation in older inpatients with a psychotic disorder

Predicting rehospitalisation in older inpatients with a psychotic disorder

Antipsychotic treatment of very late-onset schizophrenia-like psychosis (ATLAS): a randomised, controlled, double-blind trial

Amisulpride for very late-onset schizophrenia-like psychosis: the ATLAS three-arm RCT

Contact Info

Product

Resources

About