Clinical diagnosis and drug therapy of elderly patients with schizophrenia : A restrospective analysis of data in a department of old age psychiatry

Abstract

The objective of this study was to survey the consistency of the clinical diagnostics and the psychopharmacological treatment of schizophrenia and delusional disorders suffered by older persons. Afurther aspect was to record significant clinical differences and also similarities between the patient groups in care, matching with the criteria of ICD10 for schizophrenia (F20), persistent delusional disorders (F22) and schizoaffective disorder (F25). Retrospective analysis with reference to the manually and electronically recorded patient medical records of an acute case care ward for geriatric psychiatry and psychotherapy. During the assessment period 210 patients over the age of 65years were included consecutively in the study (F20 - 64patients, F22 - 78patients, F25 - 64patients, 4patients died). Ignoring the fact that many of the patients were admitted without adiagnosis, the diagnostic classification of the referring doctor, above all those made by general practitioners, proved to be very consistent for the groups F20 and F25. In the group F22 diagnoses, however, up to almost one half of the referred patients were incorrectly admitted with an F20 diagnosis. The patients included in group F22 formed aheterogeneous group, or amelting pot for various sub-groups, with the common shared characteristic of being comprised of persons suffering from adelusional disorder. These differed from the other two groups in the following attributes: the patients were either older or very old persons, they were mostly receiving inpatient treatment for the first time and subsequently had fewer re-admissions. They also suffered more frequently from both psychiatric and somatic comorbidities; furthermore they included elderly people who had suffered from learning deficiencies or borderline intellectual deficiencies throughout their earlier lives. The patients in groups F20 and F25 differed primarily only in terms of their psychiatric medication, with significantly more mood stabilizer prescribed in the F25 group. Patients in all three groups frequently received tranquilisers during the day and sedatives in the evening, atypical antipsychotics were prescribed in the great majority of cases. The referral diagnoses of patients suffering from many years of schizophrenic type illnesses were largely in compliance with the diagnostic criteria, amuch more difficult issue for the referring doctors was the allocation of patients with afirst occurrence of delusional symptoms. Those patients who were allocated to the diagnostic group schizophrenia differed significantly from patients from the group with delusional disorders.