In 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.
In 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.
Pozno nastala shizofrenija je v zadnjih letih predmet kontroverzne razprave v medicinski stroke 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.
Izhodišča: Kljub jasno postavljenim merilom s strani Zavoda za zdravstveno zavarovanje, po katerih lahko pričnemo zdravljenje bolnikov z Alzheimerjevo boleznijo, se v praksi pojavljajo mnoge dileme: ...kdaj pričeti in predvsem kdaj zaključiti zdravljenje, kolikšen naj bo odmerek, ali je zdravljenje sploh učinkovito in zato smiselno.Zaključki: V Sloveniji čedalje več bolnikov in/ali njihovih svojcev poišče pomoč v začetnih stadijih demence, vendar pa si bo kljub temu še naprej potrebno prizadevati za boljšo obveščenost in izobraževanje laikov pa tudi strokovnih delavcev. Pravilna diagnoza je temelj uspešnega zdravljenja. Zgodnja diagnoza Alzheimerjeve bolezni ni vedno enostavna zaradi vpliva telesnih bolezni, duševnih motenj ter iatrogenih ??? vzrokov upada spoznavnih sposobnosti. V pomoč so lahko merila za klinično diagnozo Alzheimerjeve bolezni. Ob tem se pogosto srečujemo s klinično slabo opredeljenim področjem mešane etiologije vaskularne demence in Alzheimerjeve bolezni. V prispevku so opisane lastnosti in pomanjkljivosti uporabe priporočenega Kratkega preizkusa spoznavnih sposobnosti. Zdravljenje naj bi, ob upoštevanju meril Zavoda za zdravstveno zavarovanje, začeli čim prej. Prekinitev zdravljenja je prepuščena individualni presoji posameznika, smiselna pa je zaradi izraženosti neželenih učinkov, ob pomanjkanju učinkovitega delovanja in v poznem stadiju bolezni.
The Psychiatric emergency clinic (PEC) was established at University Psychiatric Hospital Ljubljana in 2004. 2760 patients were examined in the PEC until the end of May 2004.
We have gathered data ...from medical documentation about the patient's age, suicidal behaviour, pharmacotherapy and psychoactive substances misuse. We compared patients with substance misuse and patients without substance misuse regarding suicidal behaviour and prescribed psychopharmacotherapy.
There was a significant difference in suicidal behaviour between the group of those, who abused PAS (n=497) and those who did not (35.4% vs. 28.0%, N = 1753, Pearson Chi-Square Test, p<0.001). More patients who abused PAS attempted suicide (9.5% vs. 3.5%, N = 2760, Fisher's Exact Test, p < 0.001). However, we have not observed a difference between the groups regarding suicidal threats and thoughts (17.2% vs. 18.0%, N = 2592, Fisher's exact test, p = NS). The subgroup of patients with PAS abuse have been prescribed pharmacotherapy more often than others (19.4% vs. 11.4%, N = 2592, Fisher's Exact Test, p < 0.001). Our data is in accordance with previous observations that PAS abuse is a risk factor for suicidal behaviour.
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