1 de diciembre de 2011

Elderly Patients with Schizophrenia and Depression: Diagnosis and Treatment

Elderly Patients with Schizophrenia and Depression: Diagnosis and Treatment
Kandi Felmet,1 Sidney Zisook,2 and John W. Kasckow1,3
1 VA Pittsburgh Health Care System MIRECC and Behavioral Health, Pittsburgh, PA
2 San Diego VAMC and University of California, San Diego, Department of Psychiatry, San Diego, CA
3 Western Psychiatric Institute and Clinics, University of Pittsburgh Medical Center, Pittsburgh, PA
Address for correspondence: Dr. John W. Kasckow, Pittsburgh VA Healthcare System 116-A, Pittsburgh, PA 15206 Phone: 412-954-4344; Fax: 412-954-5369; john.kasckow@va.gov
Abstract
Background
The treatment of older patients with schizophrenia and depressive symptoms poses many challenges for clinicians. Current classifications of depressive symptoms in patients with schizophrenia include: Major Depressive Episodes that occur in patients with schizophrenia and are not classified as schizoaffective disorder, Schizoaffective Disorder, and Schizophrenia with subsyndromal depression in which depressive symptoms do not meet criteria for Major Depression. Research indicates that the presence of any of these depressive symptoms negatively impacts the lives of patients suffering from schizophrenia-spectrum disorders.
Purpose
The purpose of this paper is to review the literature related to older patients with schizophrenia-spectrum disorders and co-occurring depressive symptoms, and to guide mental health professionals to better understand the diagnosis and treatment of depressive symptoms in patients with schizophrenia.
Conclusions
The treatment of elderly patients with schizophrenia and depressive symptoms includes first reassessing the diagnosis to make sure symptoms are not due to a comorbid condition, metabolic problems or medications. If these are ruled out, pharmacological agents in combination with psychosocial interventions are important treatments for older patients with schizophrenia and depressive symptoms. A careful assessment of each patient is needed in order to determine which antipsychotic would be optimal for their care; second-generation antipsychotics are the most commonly used antipsychotics. Augmentation with an antidepressant medication can be helpful for the elderly patient with schizophrenia and depressive symptoms. More research with pharmacologic and psychosocial interventions is needed, however, to better understand how to treat this population of elderly patients.
Keywords: Schizophrenia, Depression, Older Adult, Treatment
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