The Late‐Onset Psychoses Clinical and Diagnostic Features
The Late‐Onset Psychoses Clinical and Diagnostic Features
复制标题
迟发性精神病的临床和诊断特征
DOI：
10.1097/00005053-198508000-00006
复制
发表时间：
1985
期刊：
影响因子：
--
通讯作者：
J. Spar
中科院分区：
文献类型：
--
作者：
A. Leuchter;J. Spar
由于不一致的研究数量有限，人们对迟发性精神病知之甚少。作者进行这项研究的目的是确定一组明确的 65 岁后出现精神病的患者的临床特征，并测试 DSM-III 标准在诊断这些患者病情方面的有用性。研究期间，老年精神病科收治的患者中有 8% 发生晚发性精神病。这些患者中超过四分之三患有器质性精神障碍或严重情感障碍，其余患者患有原发性精神障碍。精神病患者的诊断比非精神病患者的可比组的可靠性要低得多，精神病组中从入院到出院期间改变诊断类别的患者数量是精神病组的五倍多。 DSM-III 诊断标准不太适合对其中许多患者进行分类。对于原发性精神障碍患者，该标准人为地对相似患者进行了细分。对于器质性精神障碍患者，该标准没有为痴呆时精神病的诊断提供足够的指导。所有三组患者均对躯体疗法有反应。一部分患有情感障碍的患者无需抗精神病药物治疗即可得到改善，几名原发性精神障碍患者受益于抗抑郁治疗。这些结果凸显了治疗迟发性精神病患者固有的困难。需要进一步的研究来制定适当的诊断标准并确定哪些患者将受益于抗精神病药和/或抗抑郁治疗。
Psychoses of late onset are poorly understood due to a limited number of inconsistent studies. The authors conducted this study to determine the clinical characteristics of a clearly defined group of patients with onset of psychosis after age 65 years and to test the usefulness of DSM-III criteria in diagnosing the condition of these patients. Late-onset psychosis occurred in 8% of the patients admitted to the geropsychiatry unit during the study period. More than three quarters of these patients suffered from either an organic mental disorder or major affective disorder, the remainder having primary psychotic disorder. The diagnoses of the psychotic patients were much less reliable than those of a comparable group of nonpsychotic patients, with more than 5 times as many patients in the psychosis group changing diagnostic categories between the time of their admission and their discharge. DSM-III diagnostic criteria were not well suited for the categorization of many of these patients. For patients with primary psychotic disorder, the criteria artificially subdivided groups of similar patients. For patients with organic mental disorder, the criteria did not provide sufficient guidance for the diagnosis of psychosis in the presence of dementia. All three groups of patients responded to somatic therapies. A subgroup of patients with affective disorder improved without neuroleptic treatment, and several patients with primary psychotic disorder benefited from antidepressant treatment. These results highlight the difficulty inherent in the treatment of patients with late-onset psychosis. Further research is needed to develop adequate diagnostic criteria and to determine which patients will benefit from neuroleptic and/or antidepressant therapy.