Posted by Sunnely on July 31, 2001, at 0:24:40
In reply to paranoia and depression in my grandmother, posted by Benjamin in RI on July 30, 2001, at 16:54:41
Psychiatric disorders (depression, psychosis, dementia) that occur in late life need to be investigated for any medical cause(s). A psychiatrist specializing in this field (geriatric psychiatrist) should be consulted.
A couple of psychiatric conditions that may occur in elderly presenting with paranoia and depression are: 1. paranoid psychosis of late life (known in the past as "paraphrenia"), 2. Alzheimer's disease complicated by paranoid delusions, 3. delusional disorder in the elderly, and 4. major depression with psychotic features (paranoia).
Paranoid psychosis of late life is usually characterized by the following:
1. usual onset after 60 years old; 2. more common in women; 3. delusions always present and almost always paranoid, persecutory, and not related to mood. Other examples of delusions include persons in their environment plotting to sexually abuse, hurt, or even kill them; being spied on; hostile persons enter their home by some mysterious means; toxic fumes pumped through the heating system into their homes; food and water poisoned; delusions of being controlled by machines; delusions of being stabbed, cut, invalidated; having telepathic experiences; 4. hallucinations may be present. Patients usually have increased sensory deficits, particularly deafness (40% in one study), and may play a role in paranoid psychosis. Therefore, patients need to be carefully evaluated with their hearing acuity (audiometry).
Thirty to 40% of elderly persons admitted to psychiatric hospitals have major depression with psychotic features. Aside from depressive features, they usually present with delusions of being persecuted, delusions of having incurable illness, delusions of guilt (about trivial episode many years prior), delusions of impending doom (nihilistic), delusions focused on the body (e.g., insides are rotting). Hallucinations are uncommon.
Alzheimer's disease can be complicated by paranoia and/or depression, along with its characteristic declining cognitive capacity (e.g., "forgetfulness", getting lost in familiar places, misplacing keys, misidentifying family or friends, declining personal care, etc., and these symptoms occur gradually).
A medical/physical condition should be ruled out first in cases of psychosis/depression or dementia occurring in the elderly. Medical conditions that may present with this clinical picture (not limited to the elderly) include and not a complete list (mnemonic: D E M N T I A):
D - Drugs (anticholinergics, steroids, blood pressure medications, sedative/hypnotics, alcohol, etc.)
E - Endocrine disorders (thyroid, parathyroid, diabetes, etc.)
M - Metabolic disorders (low sodium, high calcium, low copper [Wilson's disease], etc.)
N - Neurological/Nutritional disorders (stroke, brain tumors, Parkinson's disease, multiple sclerosis, Vitamin B12 deficiency, folic acid deficiency, pellagra, other vitamin deficiencies, etc.)
T - Tumors/Trauma (brain tumor, pancreatic carcinoma, lung carcinoma, subdural hematoma, etc.)
I - Infection/Inflammation (encephalitis, syphilis, AIDS, brain abscess, other viral infections, prion disease [mad cow disease], etc.)
A - Advancing age (Alzheimer's disease, Pick's disease, etc.)
You should have a geriatric psychiatrist evaluate your grandmother (may not cooperate due to her paranoia). Aside from a complete medical history and physical examination, she may require a battery of tests such as complete blood count, urinalysis, comprehensive metabolic panel, thyroid panel, a head CT scan or MRI, just to name a few. The test called Folstein's Mini-mental Status Examination (MMSE) usually detects presence of a dementing process. She will most likely require an antipsychotic medication (and antidepressant for depression), to control her paranoia. One of the newer antipsychotics such as Zyprexa, Risperdal, or Seroquel usually helps. Zyprexa at starting dose of 2.5 mg/day and gradually increased up to 7.5 to 10 mg/day, if necessary, usually helps in controlling psychosis. Lastly, if she cooperates, have her hearing acuity checked (audiometry).
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> My grandmother has gone through bouts of depression throughout her life.Recently she relapse dramatically. She is taking a thyroid medication but it appears that the dosage levels may be off. She is not very trusting of medication so whatever is used must be well thought out.
> She has been very paranoid, asserting that cameras in a local shopping mall had been installed to monitor her and only her. She feels that the hospital hass sent people around after her to monitor her actions. She has been trying to deal with a number of life long traumassuch as her brothers suicide on the day of her sixteenth birthday. Another brother had severe bipolar disorder. Two of her sons are currently on antidepressent therapy.
> Any suggestions into treatments, tests, or common stories would be appreciated. If you need more information to give insight please ask. Thank you for you attention.
poster:Sunnely
thread:72578
URL: http://www.dr-bob.org/babble/20010725/msgs/72662.html