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Misdiagnoses in the elderly: “late onset schizophrenia” or early dementia?

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Schizophrenia is many mental health professionals’ favorite default diagnosis. And nothing is more likely to trigger the diagnosis of schizophrenia than psychosis. But psychosis is an opaque term which may refer to a whole range of heterogeneous symptomatology. Hallucinations are likely to be viewed as psychotic manifestations even when they are not auditory like in schizophrenia but visual like in Lewy Body Dementia. When hallucinations were first noted in the elderly, the notion of “late-onset schizophrenia” was introduced. But this diagnosis is fiction more than reality in most cases. Instead, hallucinatory manifestations in the elderly should raise the possibility of a dementing process. Paranoid ideation may also be part and parcel of a dementing process rather than of schizophrenia. The correct diagnosis here is of more that merely academic importance, since treatment is predicated on it. Neuroleptics, commonly prescribed in schizophrenia, may be outright harmful in Lew Body Dementia. So don’t rush to the schizophreniadiagnosis every time you encounter psychotic-like manifestations in the elderly.

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