Coexistence of psychiatric symptoms and physical illness is one of the characteristics in old age psychiatry. Neurological disorders also commonly cause psychiatric symptoms in the elderly. Careful evaluations of somatic factors are necessary for clinical diagnosis of mental disorders in psychogeriatrics. Neuropsychiatric approaches seem to be very important for understanding psychotic symptoms in old age. Recent neuropsychiatric studies by neuropsychology and neuroimaging have revealed new aspects of behavioral consequences and psychiatric symptoms of brain dysfunctions. Further investigations in future may explore etiological and pathogenetic basis of psychiatric symptoms in elderly patients.
Mood Disorders: Various neuropsychiatric disorders may cause depression. Cerebrovascular insufficiency and stroke frequently induce depressive state. Neurodegenerative disorders, like Alzheimer's disease and Parkinson's disease, are also common causes of depression. Psychopathologies of depression, induced by neurological disorders, are essentially the same as those of endogenous depression. However, some differences could be pointed out. Insomnia, anorexia, low self-esteem, obsessive compulsive symptom, suicidal ideation are not prominent, whereas instability of mood, hostility, violent behavior, slow speech and thought retardation, lack of insight, and flatness of affect appear remarkable in organic mood disorders. However, occasionally, it is not easy to differentiate coincidental mood changes in the normal aged from organic mood disorders.
Hallucinations and Delusions: Visual hallucinations and persecutory delusions (to be stolen personal objects) are common in Alzheimer's disease patients. Persecutory delusion is also frequent in the patients with Huntington's disease. Cerebrovascular disorders and brain injury may cause hallucination and delusion. Vivid visual illusions and hallucinations are common in patients with Parkinson's disease, treated by dopaminergic drugs. Capgra's syndrome, delusional misidentification, and visual hallucinations are frequently seen in the patients with Lewy body disease.
Personality Change: Accentuation of previous personality traits, irritability, apathy, and exaggerated emotionality are characteristic personality alterations in organic brain disorders as well as in normal aging.
Disturbance of Consciousness: Delirium is usually induced by physical illness and/or organic brain disorders. Visual hallucination and illusion, insomnia, and disorientation are common symptoms of delirium. Confused behaviors occasionally mimic endogenous psychoses or dementia. Hallucinations and confusions are well-known side effects of long-term treatment with levodopa in Parkinson's disease.
Cognitive Impairments: Persistent widespread degeneration of cerebrum cause cognitive and non-cognitive impairments, namely dementia, in the elderly. Age-associated cognitive impairment and mild cognitive impairment (MCI) are not easy to differentiate from the early stage of dementia. Psychological and behavioral symptoms (BPSD) are usually seen in dementing disorders. Mental disorders, like depression, hallucination and delusion, as well as behavioral symptoms, like aggression, screaming, restlessness, agitation and wandering, are also seen in the patients with dementia.
Conclusion: Psychiatric symptoms are frequently accompanied by physical illness and/or brain disorders in elderly patients. However, at this moment, it is not easy to evaluate exactly how the somatic factors participate to cause psychotic symptoms in old patients. Neuropsychiatric investigations in the future are essential for further understanding of the psychiatric symptoms in aged patients.
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