Treatment of psychosis in elderly people

Karim, Salman; Byrne, E. Jane

doi:10.1192/apt.11.4.286

Cited by 35 publications

(22 citation statements)

References 80 publications

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“…govor (1,4,6,7,12,18). Afektivnost je manj prizadeta, boljše je socialno funkcioniranje, pač pa je več preganjalnih blodenj in halucinacij (6).…”

Section: Klinične Značilnostiunclassified

“…Za shizofrenijo je ne glede na čas nastopa simptomov značilna kompleksna, večvzročna patogeneza, v katero so vključene genetika in posameznikove osebnostne in socialne značilno-sti (4)(5)(6)(7)12,18). Patogeneza LOS se po vsej verjetnosti razlikuje tako od EOS kot tudi od VLOSLP, pri čemer gre pri prvi verjetno za povezanost z razvojnimi procesi, pri drugi pa za degenerativne spremembe (1,5).…”

Section: Patologija In Patogenezaunclassified

“…S slikovno diagnostiko so v možganih bolnikov z LOS ugotovili konsistentno ponavljanje najdb nespecifičnih strukturnih sprememb (1,7,18) ter zmanjšane-ga razmerja med prostornino hemisfer in ventriklov v primerjavi z zdravimi osebami primerljive starosti (1,5,7), ki se s potekom bolezni še manjša (3). Raziskave so pokazale tudi bolj specifične, čeprav težko razložljive najdbe: bilateralno izgubo bele substance ob sorazmerno dobro ohranjeni sivini v parahipokampalnem girusu v primerjavi tako z bolniki z EOS kot tudi s kontrolno skupino (5) ter žariščne strukturne spremembe prostornine v predelu levega temporalnega režnja in superiornega temporalnega girusa, kar pa je identično kot pri EOS (1,7).…”

Section: Slikovna Diagnostikaunclassified

“…Najpogosteje se uporabljata olanzapin in risperidon, prvi v začetnih odmerkih 2,5 mg enkrat na dan, drugi pa od 0,5 mg enkrat na dan naprej. Začetni dnevni odmerki so nižji, potrebno pa jih je postopno povečevati in ob tem spremljati učinek in neželene učinke zdravila (1,(3)(4)(5)9,10,18,22). Priporoče-no je rutinsko spremljanje prehrane in telesne teže, beleženje EKG (možno podaljšanje QTc intervala), pozornost na padce in ekstrapiramidne neželene učinke, spremljanje plazemske koncentracije prolaktina (osteoporoza), lipidov in glukoze (tveganje za nastanek na inzulin odporne sladkorne bolezni) (5).…”

Section: Zdravljenjeunclassified

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Shizofrenija z začetkom v poznem življenjskem obdobju

2018

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IzvlečekPozno nastala shizofrenija je v zadnjih letih predmet kontroverzne razprave v medicinski stroki predvsem zaradi težave pri doseganju konsenza glede postavitve same diagnoze. V članku skušamo na enem mestu pregledno povzeti znanstvene vire, nastale v preteklih desetletjih, in podati celostni pregled od diagnoze do zdravljenja te dokaj pogoste bolezni. Od zgodaj nastale shizofrenije se pozno nastala razlikuje po simptomih, zdravljenju, napovedi izida ter patogenezi, v kateri naj bi pri zgodaj nastali prevladovala motnja v razvoju, medtem ko gre pri pozno nastali po vsej verjetnosti za degenerativen proces znotraj centralnega živčnega sistema. Posebna pozornost pa je potrebna pri diferencialnodiagnostični obravnavi bolnikov, pri katerih sumimo, da gre za to bolezen. Izključiti je namreč potrebno degenerativne bolezni, ekspanzivne procese, nevrološke in psihiatrične motnje ter nazadnje tudi zlorabo psihoaktivnih snovi. V zadnjem času je veliko raziskav tudi s področja vloge genetike v patogenezi bolezni, vendar pa je poznavanje genetskega vpliva za klinično diagnostiko v tem trenutku še nezadostno. Zlati standard pri diagnosticiranju pozno nastale shizofrenije tako še naprej ostaja klinični pregled bolnika. Za konec pa smo poudarili tudi posebnosti farmakoterapije ter povzeli aktualne smernice zdravljenja pozno nastale shizofrenije. AbstractIn recent years, late-onset schizophrenia is a subject of controversial debate in the medical profession largely due to difficulties in reaching a consensus on the diagnosis of the disorder. In the present article we try to summarize in one place the scientific resources that were studying this disorder in the past decades and present a comprehensive overview from diagnosis to treatment of this relatively common disorder. Late-onset schizophrenia differs from early-onset schizophrenia in terms of symptoms, treatment, prognosis and pathogenesis, which is in early-onset schizophrenia based mainly on the developmental causes, whereas late-onset schizophrenia is most likely the result of a degenerative process within the central nervous system. Differential diagnosis of this disorder can be especially challenging and therefore demands additional attention. It is necessary to exclude degenerative diseases, expansive processes, neurological and psychiatric disorders, and ultimately, the abuse of psychoactive substances. Lately, there has been a lot of research done on genetic causes that could explain pathogenesis of the disorder, however, knowledge of the genetic influence for the establishment of clinical diagnosis is at this moment still inadequate. Thus, a clinical examination of the patient still remains the gold standard for the diagnosis of late-onset schizophrenia.. Finally, we highlight the particularities of pharmacotherapy and summarize the current treatment guidelines for late-onset schizophrenia.

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“…govor (1,4,6,7,12,18). Afektivnost je manj prizadeta, boljše je socialno funkcioniranje, pač pa je več preganjalnih blodenj in halucinacij (6).…”

Section: Klinične Značilnostiunclassified

Section: Patologija In Patogenezaunclassified

Section: Slikovna Diagnostikaunclassified

Section: Zdravljenjeunclassified

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Shizofrenija z začetkom v poznem življenjskem obdobju

2018

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“…parkinsonism, akathisia, acute dystonia, tardive dyskinesia). In turn, such effects may lead to falls due to problems with balance, and weight loss due to problems with eating and swallowing 15. Older patients are particularly at risk of developing tardive dyskinesia, which may be irreversible (even if therapy is stopped) and unresponsive to treatment 8.…”

Section: Conventional Antipsychotic Drugsmentioning

confidence: 99%

How safe are antipsychotics in dementia?

2007

DTB

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Around 800,000 people in the UK have dementia, about 80% of whom will have behavioural changes or psychological symptoms in the course of the illness. Such features lower quality of life for both patients and carers, and often result in transfer to residential care and higher costs. Currently, no drugs are licensed in the UK specifically for behavioural changes and psychological symptoms in patients with dementia. Nevertheless, antipsychotic medications have been used in people with dementia, both for psychotic symptoms and also for less specific problems such as agitation and aggression. There have been long-standing concerns about the inappropriate use of these drugs in such settings. In 2004, following worries over an increased likelihood of stroke with risperidone and olanzapine, the former UK Committee on Safety of Medicines (CSM) advised that these drugs "should not be used for the treatment of behavioural symptoms of dementia". However, this led to reports of unsuitable interpretation of the guidance, with groups of patients having their medication withdrawn inappropriately or being switched to other, potentially more harmful, drugs. Here we assess the safety of antipsychotic medication in people with dementia.

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