Evidence that onset of psychosis in the population reflects early hallucinatory experiences that through environmental risks and affective dysregulation become complicated by delusions

Objective:

To examine the hypothesis that the “natural” combination of delusions and hallucinations in psychotic disorders in fact represents a selection of early subclinical hallucinatory experiences associated with delusional ideation, resulting in need for care and mental health service use.

Methods:

In the Early Developmental Stages of Psychopathology study, a prospective, 10-year follow-up of a representative cohort of adolescents and young adults in Munich, Germany (n = 2524), clinical psychologists assessed hallucinations and delusions at 2 time points (T2 and T3). Analyses compared differences in psychopathology, familial liability for nonpsychotic disorder, nongenetic risk factors, persistence, and clinical outcome between groups characterized by: (1) absence of positive psychotic symptoms, (2) presence of isolated hallucinations, (3) isolated delusions, and (4) both hallucinations and delusions.

Results:

Delusions and hallucinations occurred together much more often (T2: 3.1%; T3: 2.0%) than predicted by chance (T2: 1.0%; T3: 0.4%; OR = 11.0; 95% CI: 8.1, 15.1). Content of delusions was contingent on presence of hallucinations but modality of hallucinations was not contingent on presence of delusions. The group with both hallucinations and delusions, compared to groups with either delusions or hallucinations in isolation, displayed the strongest associations with familial affective liability and nongenetic risk factors, as well as with persistence of psychotic symptoms, comorbidity with negative symptoms, affective psychopathology, and clinical need.

Conclusions:

The early stages of psychosis may involve hallucinatory experiences that, if complicated by delusional ideation under the influence of environmental risks and (liability for) affective dysregulation, give rise to a poor prognosis hallucinatory–delusional syndrome.     

Post‐marketing survey of donepezil hydrochloride in Japanese patients with Alzheimer's disease with behavioral and psychological symptoms of dementia (BPSD)

Background: To investigate the efficacy and safety of donepezil hydrochloride (Aricept^®; Eisai Co., Ltd, Tokyo, Japan), we conducted a post‐marketing survey in Japanese patients with Alzheimer's disease (AD) who also had behavioral and psychological symptoms of dementia (BPSD), such as hallucinations/delusions, wandering, and aggression, which cause the greatest burden on caregivers. Methods: A prospective, centrally registered investigation was conducted through regular clinical settings with patients diagnosed as mild to moderate AD presenting with hallucinations/delusions, wandering, and/or aggression. The treatment period was 12 weeks and no restrictions were placed on concomitant medications. Results: The BPSD improvement rates at last‐observation‐carried‐forward (LOCF) were 60.1% for hallucinations/delusions, 59.6% for wandering, and 65.6% for aggression. For all symptoms, improvement rates increased with the duration of the treatment period. The BPSD deterioration rates at LOCF were 1.3% for hallucinations/delusions, 3.4% for wandering, and 1.6% for aggression. Assessment of cognitive function with both the revised Hasegawa Dementia Scale (HDS‐R) and Mini‐Mental State Examination (MMSE) indicated significant improvements after treatment. There were significant differences in the changes in HDS‐R scores between patients whose hallucinations/delusions or wandering were improved and patients whose symptoms were not improved. Moreover, the data suggested a possible correlation between changes in hallucinations/delusions and HDS‐R scores, changes in hallucinations/delusions and MMSE scores, and changes in wandering and MMSE scores. Patients in whom BPSD improved also demonstrated a greater improvement in cognitive function compared with patients in whom no improvement in BPSD was noted. Nursing burden on caregivers at LOCF showed 3.6% for ‘No burden’, 54.1% for ‘Burden decreased’, and 4.5% for ‘Burden increased.’ There was an increase in the combined ratio of ‘No burden’ and ‘Burden decreased’ in proportion with prolonged treatment period. Patients with improved BPSD had a significantly greater ratio (88.5–94.4%) of ‘No burden’ plus ‘Burden decreased’ than those patients in whom no improvement in BPSD was noted. Conclusions: These results suggest that donepezil not only improves the cognitive dysfunction of AD patients, but may also relieve BPSD in these patients. Treatment with donepezil was also found to alleviate the burden of caregivers for approximately 60% of patients. Moreover, the results indicate that donepezil is unlikely to trigger potential risks of excessive deterioration of BPSD, which would result in a heavier burden of nursing care.     

Evidence for the early clinical relevance of hallucinatory‐delusional states in the general population

Nuevo R, Van Os J, Arango C, Chatterji S, Ayuso‐Mateos JL. Evidence for the early clinical relevance of hallucinatory‐delusional states in the general population. Objective: To analyze, in a general population sample, clustering of delusional and hallucinatory experiences in relation to environmental exposures and clinical parameters. Method: General population‐based household surveys of randomly selected adults between 18 and 65 years of age were carried out. Setting: 52 countries participating in the World Health Organization’s World Health Survey were included. Participants: 225 842 subjects (55.6% women), from nationally representative samples, with an individual response rate of 98.5% within households participated. Results: Compared with isolated delusions and hallucinations, co‐occurrence of the two phenomena was associated with poorer outcome including worse general health and functioning status (OR = 0.93; 95% CI: 0.92–0.93), greater severity of symptoms (OR = 2.5 95% CI: 2.0–3.0), higher probability of lifetime diagnosis of psychotic disorder (OR = 12.9; 95% CI: 11.5–14.4), lifetime treatment for psychotic disorder (OR = 19.7; 95% CI: 17.3–22.5), and depression during the last 12 months (OR = 11.6; 95% CI: 10.9–12.4). Co‐occurrence was also associated with adversity and hearing problems (OR = 2.0; 95% CI: 1.8–2.3). Conclusion: The results suggest that the co‐occurrence of hallucinations and delusions in populations is not random but instead can be seen, compared with either phenomenon in isolation, as the result of more etiologic loading leading to a more severe clinical state.     

The changing face of Parkinson's disease‐associated psychosis: A cross‐sectional study based on the new NINDS‐NIMH criteria

New criteria for Parkinson's disease‐associated psychosis (PDAP) were recently proposed by a NINDS‐NIMH working group. We assessed 116 consecutive unselected outpatients with PD for the existence of psychotic symptoms during the previous month, using a structured questionnaire covering the whole spectrum of PDAP symptoms. Hallucinations occurred in 42% of the patients (visual: 16%; nonvisual: 35%), delusions in 4%, and minor symptoms in 45% (sense of presence, visual illusions, or passage hallucinations). The prevalence of PDAP was 43% when the usual definition was used (hallucinations and/or delusions) and 60% when the NINDS‐NIHM criteria were used. Correlations between PDAP and patient characteristics varied with the definition of PDAP. These findings suggest that the epidemiology of PDAP should be re‐evaluated with the new criteria. Minor symptoms and nonvisual hallucinations are an important part of the PDAP spectrum, which has commonly been restricted to visual hallucinations and delusions. © 2010 Movement Disorder Society     

A latent class analysis of psychosis-like experiences in the New Zealand Mental Health Survey

Gale CK, Wells JE, McGee MA, Oakley Browne MA. A latent class analysis of psychosis‐like experiences in the New Zealand Mental Health Survey. Objective: To describe the underlying structure of psychosis‐like experiences in the New Zealand Mental Health Survey. Method: A nationwide survey of household residents aged 16+ years was undertaken (n = 7435), using the Composite International Diagnostic Interview (3.0), including a six question lifetime screener for psychosis. Participants were grouped in three ways: by the number of ‘symptoms’ (occurring when not dreaming, half‐asleep or under the influences of drugs) and by latent classes derived from binary responses (no/yes) or ordinal responses (never/sub‐threshold/few times/many times). Results: Psychosis‐like events were not uncommon (7.3%; 95% CIs 6.5–8.1), particularly experiences of visual (5.3%; 95% CIs 4.7–6.0) or auditory hallucinations (2.8%; 95% CIs 2.3–3.3). Both latent class analyses indicated a ‘normal’ class, a ‘hallucinatory class’ and a ‘psychotic’ class. The lifetime probability of anxiety, mood or substance disorders and the lifetime probability of seeking help for mental health problems increased from ‘normal’ to ‘hallucinatory’ to ‘psychotic’ classes and with the ‘symptom’ count. Conclusion: The presence of sub‐threshold events and variation in the number of times a ‘symptom’ is experienced suggest a psychosis continuum. However, the latent classes labelled ‘hallucinatory’ and ‘psychotic’ differ markedly in symptomatology, which suggests some form of discrete clustering.     

The psychosis of schizophrenia: prevalence, response to atypical antipsychotics, and prediction of outcome.

BACKGROUND: Psychosis is a defining feature of schizophrenia consisting of formal thought disorder, delusions, and hallucinations. Although psychosis is present in the majority of patients with schizophrenia, the prevalence, responsiveness to atypical antipsychotic drug therapy, and prediction of outcome of individual psychotic symptoms in a population of well-diagnosed patients with schizophrenia have not been conclusively established. METHODS: This paper examined the prevalence, responsiveness to the atypical antipsychotic olanzapine, and relationship to outcome of individual psychotic symptoms using data from a previously reported large multicenter, double-blind clinical trial of olanzapine (mean daily dose at endpoint = 13.6 +/- 6.9 mg/day). RESULTS: The most frequently reported psychotic symptoms at baseline were delusions (65%), conceptual disorganization (50%), and hallucinations (52%), and the majority of patients (68%) experienced from one to three symptoms. Additionally, with olanzapine treatment there were significant improvements (p < .001) in baseline to endpoint Positive and Negative Symptom Scale (PANSS) psychotic item scores, with the largest effect sizes observed for hallucinatory behavior, unusual thought content, suspiciousness/persecution, and delusions. During the acute phase of the trial, quality of life was correlated significantly with baseline conceptual disorganization (p = .038) and unusual thought content (p = .023), and time spent in the hospital was correlated with unusual thought content (p = .005). CONCLUSIONS: The implications of these for the clinical management of schizophrenia are discussed.     

Caregiver report of hallucinations and paranoid delusions in elders aged 70 or older

This study examined the demographic, medical, and psychiatric correlates of hallucinations and paranoid delusions reported by proxy informants for 822 elders aged 70 or older. This sample comprised people who were deemed unable to complete a direct interview in a large nationwide study of aging. Marital status, trouble with vision, and cognitive impairment were associated with report of both paranoid delusions and hallucinations. Depressive symptoms and stroke were associated with hallucinations only. These results suggest that inadequate external stimulation in the elderly leads to psychotic experiences.     

Psychotic symptoms in Alzheimer's disease

Memory loss is the hallmark of Alzheimer' disease. However, psychotic symptoms have also been reported. We studied the prevalence of hallucinations and delusions in 677 subjects with probable Alzheimer' disease. Data were collected in six centers and analyzed retrospectively. A two-stage, multivariate approach was used. The overall prevalence of these psychotic symptoms was 31%. The prevalence of hallucinations was 17%, and of delusions 26%. Both were associated with emotional incontinence, insomnia and agitation as well as with advanced disease. While psychotic symptoms were more prevalent in advanced disease, nonetheless they occurred with notable frequency in early disease. Of subjects with early AD (MMSE scores between 21 and 30), 6% had hallucinations and 17% had delusions. Alzheimer' disease must be considered in the differential diagnosis of any subject over 55 presenting with these psychotic symptoms.     

Pathogenesis and symptomatology of hallucinations (delusions) of organic brain disorder and schizophrenia

In this review article, in order to explore the mechanisms underlying the hallucinations/delusions of schizophrenia, we discuss the contribution of the following four questions: (i) can an understanding of dreams contribute to our understanding of the genesis of halluciations and/or delusions; (ii) are the mechanisms underlying psychotropic drug‐induced psychoses the same as those underlying the hallucinations and/or delusions in schizophrenia; (iii) does disturbed consciousness contribute to the manifestation of psychotic features; and (iv) are the psychoses caused by organic brain disorders any different to the hallucinations and/or delusions seen in schizophrenia? We conclude that there is a strong association between drug‐induced hallucinations or hallucinations associated with organic brain disorders and simple hallucinosis or fluctuations in arousal level. Because intermediate configurations and/or cross‐staining phenomena exist for hallucinations and delusions, especially in schizophrenic disorders, it is difficult to isolate the hallucinations and to recognize them as being abnormal experiences.     

Psychotic‐spectrum symptoms,cumulative adversity exposure and substance use among high‐risk girls

Aim

Psychotic‐spectrum symptoms are linked to trauma, substance/alcohol use (SAU), criminality/violence and poor functional outcomes, supporting the need for early detection in vulnerable populations. To better understand high‐risk girls’ mental health, we assessed: (1) psychotic‐spectrum symptoms; (2) cumulative trauma, adversity and loss exposures (C‐TALE) and adversity‐indicators (symptoms, maladaptive coping, stressor‐reactivity); and SAU risk‐factors; and (3) relationships among psychotic‐spectrum symptoms, adversity‐indicators and SAU risk‐factors.

Methods

We administered the Structured Clinical Interviews for Psychotic Spectrum, and Trauma and Loss Spectrum to 158 adolescent delinquent girls.

Results

Girls’ psychotic‐spectrum profiles were similar to previously reported adult psychotic patients and characterized by typical symptoms (hallucinations/delusions, reported largely SAU‐independent), interpersonal sensitivity, schizoid traits and paranoia (over‐interpretation, anger over‐reactivity, hypervigilance). Auditory/visual hallucinations (55.7%), delusions (92.4%), ideas of reference (96.8%) and adversity (90.0% ≥10/24 C‐TALE‐types) were common. Mean loss (4) and trauma (8) onset‐age occurred before SAU‐onset (12). Significant positive correlations were found among psychotic‐spectrum symptoms, stressor‐reactivity, C‐TALE, adversity‐indicators; and number of SAU‐types; and a negative correlation occurred between psychotic‐spectrum symptoms and earlier alcohol use onset. After controlling for number of SAU‐types, stressor‐reactivity and adversity‐related numbing individually had the largest associations with total psychotic‐spectrum symptoms (b = 2.6‐4.3). Girls averaged more than 4 maladaptive coping strategies (e.g., 24.8% attempted suicide) in response to adversity, amplifying potential health‐disparities. No racial/ethnic differences emerged on psychotic‐spectrum symptoms.

Conclusions

This symptom constellation during adolescence likely interferes with social and academic functioning. Whether representing a prodromal phase, trauma‐response or cross‐diagnostic psychopathology, accurate early detection and appropriate treatment of psychotic‐spectrum symptoms are warranted to improve functional outcomes in vulnerable populations.     

Cross-sectional and longitudinal associations between psychotic and depressive symptoms in depressed adolescents

Adults with major depressive disorder (MDD) with psychotic features (delusions and/or hallucinations) have more severe symptoms and a worse prognosis. Subclinical psychotic symptoms are more common in adolescents than adults. However, the effects of psychotic symptoms on outcome of depressive symptoms have not been well studied in adolescents. Depressed adolescents aged 11–17 with and without psychotic symptoms were compared on depression severity scores at baseline and at 28- or 42-week follow-up in two large UK cohorts. Psychotic symptoms were weakly associated with more severe depression at baseline in both cohorts. At follow-up, baseline psychotic symptoms were only associated with depressive symptoms in one sample; in the other, the effect size was close to zero. This supports the DSM5 system of psychotic symptoms being a separate code to severity rather than the ICD10 system which only allows the diagnosis of psychotic depression with severe depression. There was no clear support for psychotic symptoms being a baseline marker of treatment response.

     

A comparative study of psychiatric symptoms in dementia with Lewy bodies and Parkinson's disease with and without dementia

OBJECTIVES: To compare the frequency and clinical correlates of neuropsychiatric symptoms in patients with Parkinson's disease (PD) with and without dementia and in those with dementia with Lewy bodies (DLB). METHODS: Neuropsychiatric symptoms during the month prior to assessment were assessed in clinically diagnosed PD patients with dementia (PDD; n = 48) and without dementia (PDND; n = 83) and in 98 DLB patients (33% autopsy confirmed) using standardized instruments. RESULTS: Delusions and hallucinations were significantly more common in DLB (57% and 76%) than PDD (29% and 54%) and PDND (7% and 14%) patients (p < 0.001). In all groups, auditory and visual hallucinations and paranoid and phantom boarder delusions were the most common psychotic symptoms. Frequency of major depression and less than major depression did not differ significantly between the three groups. Clinical correlates of hallucinations in PD were dementia (odds ratio (OR) = 3.9; 95% confidence interval (CI) 1.5-10.4) and Hoehn-Yahr stage 3 or more (OR 3.4; 95% CI 1.0-12.0), whereas no significant clinical correlates of hallucinations were found in DLB patients. CONCLUSIONS: Delusions and hallucinations occur with increasing frequency in PDND, PDD and DLB patients, but the presentation of these symptoms is similar. These findings support the hypothesis that psychiatric symptoms are associated with cortical Lewy bodies or cholinergic deficits in the two disorders.     

Psychotische Syndrome bei kriegstraumatisierten älteren Patienten

BACKGROUND: Late-onset post-traumatic stress disorder (PTSD) patients with traumatic experiences from World War II often present psychotic features. METHODS: Twelve psychotic elderly PTSD patients were compared with 22 nonpsychotic elderly PTSD patients for age, marital status, age of traumatization, age of onset of psychiatric symptoms, and psychiatric comorbidities. The contents of delusions and hallucinations were registered as well as trauma details. RESULTS: The psychotic PTSD patients were significantly older (80 years vs 74), later traumatized (20 years vs 14), more frequently demented (75% vs 27%), and more frequently widowed (83% vs 50%). The contents of their psychotic features often were related to traumatic experiences in early life. CONCLUSIONS: Psychoses of traumatized elderly patients should be registered regarding psychotic content to discover a possible relation between traumatic experiences and psychosis. The International Classification of Diseases 11th Edition should include the subtype "PTSD with simultaneous psychotic features."     

Initial magnetic resonance imaging volumetric brain measurements and outcome in schizophrenia: a prospective longitudinal study with 5-year follow-up.

BACKGROUND: Several demographic and phenomenological variables have been identified as predictors of outcome in schizophrenia. Far fewer studies have examined the relationships between brain morphology assessed at illness onset and subsequent outcome, and their results have been contradictory. METHODS: The relationships between magnetic resonance imaging (MRI) regional brain volumes at illness onset and outcome five years later were studied in 123 schizophrenia patients using regression and correlation analysis. Outcome measures included psychosocial functioning, weeks per year receiving inpatient treatment, and persistence of severe psychotic, disorganized and negative symptoms. RESULTS: Temporal lobe tissue volume at onset was predictive of outcome. Smaller temporal lobe gray matter volume (both left and right) was associated with persistence of hallucinations during follow-up. There were no significant associations between hallucinations and temporal white matter, or between delusions and temporal white or gray matter volumes. None of the other volumetric brain measures were predictive of outcome. CONCLUSIONS: The association between initial temporal lobe gray matter volume and subsequent persistent hallucinations may help identify individuals who are at higher risk for poor outcome and help guide their treatment planning. However, regional brain volumes assessed near illness onset, in general, do not appear to be indicative of subsequent outcome in schizophrenia.     

Can obsessions drive you mad? Longitudinal evidence that obsessive‐compulsive symptoms worsen the outcome of early psychotic experiences

Van Dael F, van Os J, de Graaf R, ten Have M, Krabbendam L, Myin‐Germeys I. Can obsessions drive you mad? Longitudinal evidence that obsessive‐compulsive symptoms worsen the outcome of early psychotic experiences. Objective: Although there is substantial comorbidity between psychotic disorder and obsessive‐compulsive disorder (OCD), little is known about how these clinical phenotypes, and their subclinical extended phenotypes, covary and impact on each other over time. This study examined cross‐sectional and longitudinal associations between both (extended) phenotypes in the general population. Method: Data were obtained from the three waves of the NEMESIS‐study. A representative population sample of 7076 participants were assessed using the composite international diagnostic interview (CIDI) at baseline (T₀), 1 year later at T₁ and again 2 years later at T₂. Results: At T₀, a lifetime diagnosis of psychotic disorder was present in 1.5% of the entire sample, in 11.5% of the people with any OC symptom and in 23.0% of individuals diagnosed with OCD. OC symptoms at T₀ predicted incident psychotic symptoms at T₂. Similarly, T₀ psychotic symptoms predicted T₂ OC symptoms. The likelihood of persistence of psychotic symptoms or transition to psychotic disorder was higher if early psychosis was accompanied by co‐occurring OC symptoms, but not the other way around. Conclusion: OCD and the psychosis phenotype cluster together and predict each other at (sub)clinical level. The co‐occurrence of subclinical OC and psychosis may facilitate the formation of a more ‘toxic’ form of persistent psychosis.     

Clinical predictors of course and outcome in delusional psychosis

The purpose of the study was to examine whether clinical variables of first-admitted patients with delusional psychosis were of predictive importance of course and outcome illuminated through the dimensions: psychotic symptoms, impairment, remission, and relapse at 2-year follow-up. Male, sex, age below 30 years, unmarried, long duration of psychosis, and absence of psychosocial stress prior to first admission were all statistically predictive of poor outcome. Concerning nonspecific psychological distress high mean values on the subscales of helplessness-hopelessness, dread and antisocial history were correlated to poor outcome as was low mean value of active expression of hostility. Concerning psychopathology assessed by PSE individual items as lost emotions, thought insertion, thought broadcast, primary delusions and certain auditory hallucinations (voices discussing/commenting subject in third person) predicted poor outcome. Further classes of PSE symptoms as perceptual disorder, thought disorder, and delusions of influence predicted poor outcome too. Other prognostic unfavourable variables were systematisation of delusions, severe preoccupation with present delusions and no suspicion of attempt at concealment of delusions and hallucinations.     

Duration of untreated psychosis and time to treatment response for delusions and hallucinations

OBJECTIVE: Duration of untreated psychosis is associated with time to treatment response among patients with schizophrenia. However, individual psychotic symptoms have not been investigated in this context. The authors examined the relationship between duration of untreated psychosis and time to response for hallucinations and delusions. METHOD: Data were available for 118 patients with first-episode schizophrenia in a longitudinal treatment study. Patients received open-label treatment with conventional antipsychotics and were followed for up to 5 years. Duration of untreated psychosis was correlated with time to response for delusions and hallucinations, and predictors of time to response were examined. RESULTS: Time to response for delusions was significantly longer than that for hallucinations. Duration of untreated psychosis was significantly correlated with time to response for delusions but not for hallucinations. In regression analyses, duration of untreated psychosis was the only predictor for time to response for delusions; it was not a predictor for hallucinations. CONCLUSIONS: The results suggest that duration of untreated psychosis may be specifically associated with time to response for delusions. This association may have clinical implications.     

A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia.

OBJECTIVE: To compare citalopram and risperidone for the treatment of psychotic symptoms and agitation associated with dementia, with a priori hypotheses that risperidone would be more efficacious for psychosis and citalopram for agitation. METHODS: A 12-week randomized, controlled trial in nondepressed patients with dementia hospitalized because of behavioral symptoms (N = 103) was conducted at the University of Pittsburgh Medical Center. Participants were consecutively recruited on an inpatient unit if they had at least one moderate to severe target symptom (aggression, agitation, hostility, suspiciousness, hallucinations, or delusions). Once they improved sufficiently, they were discharged to nursing homes, personal care homes, or residential homes for continued treatment. Planned pre-post and mixed model analyses of the main outcome measures of Neurobehavioral Rating Scale and Side Effect Rating Scale at baseline and at weekly/biweekly intervals were conducted. RESULTS: Completion rates did not differ for citalopram and risperidone (overall completion rate: 44%). Agitation symptoms (aggression, agitation, or hostility) and psychotic symptoms (suspiciousness, hallucinations, or delusions) decreased in both treatment groups but the improvement did not differ significantly between the two groups. There was a significant increase in side effect burden with risperidone but not with citalopram such that the two groups differed significantly. CONCLUSION: No statistical difference was found in the efficacy of citalopram and risperidone for the treatment of either agitation or psychotic symptoms in patients with dementia. These findings need to be replicated before citalopram or other serotonergic antidepressants can be recommended as alternatives to antipsychotics for the treatment of agitation or psychotic symptoms associated with dementia.     

Demographic correlates of psychotic-like experiences in young Australian adults

Objective: Psychotic‐like experiences (PLE) in the general community are common. The aims of this study were to examine the prevalence and demographic correlates of PLE in young adults. Method: The sample consisted of 2441 subjects aged 18–23 years. Subjects completed the Composite International Diagnostic Interview (CIDI) and the 21‐item Peters Delusional Inventory (PDI). Associations between age, gender, hallucinations and delusions were examined using logistic regression. Results: Both CIDI hallucinations and delusions predicted high scores on the PDI. Younger age was significantly associated with endorsement of CIDI delusions [odds ratio (OR) = 0.66, 95% confidence interval (CI) 0.48–0.92) and with PDI total scores (OR = 0.68, 95% CI 0.55–0.83). Women were significantly more likely to endorse items related to hallucinations (OR = 1.49, 95% CI 1.14–1.95) but not delusions. Conclusion: PLE are common in young adults. The mechanisms underpinning the age and gender gradients in PLE may provide clues to the pathogenesis of psychotic disorders.     

Basal ganglia calcification and psychotic symptoms in the very old

BACKGROUND: Basal ganglia calcification (BGC) is associated with psychotic symptoms in young and middle-aged patient samples. METHODS: We studied the cross-sectional relationship between psychotic symptoms and BGC in a population sample of non-demented 85-year-olds, of whom 86 were mentally healthy, 11 had hallucinations or delusions, 21 had mood disorders and 20 had anxiety disorders. BGC was measured using computerized tomography (CT). Mental disorders were diagnosed using DSM-III-R criteria and psychotic symptoms were evaluated using information from psychiatric examinations, key-informant interviews and review medical records. RESULTS: BGC on CT was observed in 19% of mentally healthy and 64% of non-demented individuals with hallucinations or delusions [Odds Ratio (OR) 7.7, 95% Confidence Intervals (CI) 2.9-29.7, p=0.003]. There were no associations between BGC and mood or anxiety disorders. CONCLUSIONS: BGC is strongly associated with psychotic symptoms in very old age, possibly due to a disturbance in the basal ganglia dopaminergic system.