Ostling Svante, Skoog Ingmar
Göteborg University, Institute of Clinical Neuroscience, Psychiatry Section, Sahlgrenska University Hospital/S, SE 413 45 Göteborg, Sweden.
Arch Gen Psychiatry. 2002 Jan;59(1):53-9. doi: 10.1001/archpsyc.59.1.53.
Psychotic symptoms are reported to be uncommon in the elderly, and may be underrated in traditional epidemiological studies.
Psychotic symptoms, physical disorders, disability in daily life, and sensory impairments were assessed using results of psychiatric and physical examinations, key-informant interviews, and medical record reviews in a representative sample of nondemented individuals aged 85 years living in the community or in institutions in Göteborg, Sweden (n = 347). The sample was observed for 3 years regarding psychotic symptoms, mortality, and incident dementia.
The prevalence of any psychotic symptom was 10.1% (95% confidence interval [CI], 7.1%-13.7%); hallucinations, 6.9% (95% CI, 4.5%-10.1%); and delusions, 5.5% (95% CI, 3.3%-8.4%). The prevalence of paranoid ideation was 6.9% (95% CI, 4.5%-10.1%). Stepwise logistic regression analyses showed that hallucinations were associated with major depressive syndrome (odds ratio [OR], 3.9; 95% CI, 1.3-11.9), disability in daily life (OR, 5.2; 95% CI, 1.8-14.9), and visual deficits (OR, 3.4; 95% CI, 1.0-11.1). Delusions were associated with disability in daily life (OR, 4.9; 95% CI, 1.8-13.3). Paranoid ideation was associated with visual deficits (OR, 3.6; 95% CI, 1.2-10.5) and myocardial infarction (OR, 4.6; 95% CI, 1.7-12.6). Hallucinations (OR, 3.1; 95% CI, 1.4-6.8), delusions (OR, 2.9; 95% CI, 1.2-6.9), and paranoid ideation (OR, 2.7; 95% CI, 1.2-6.2) were each related to increased incidence of dementia from 85 to 88 years of age. Hallucinations and paranoid ideation were associated with increased 3-year mortality in women but not in men.
We found a higher prevalence of psychotic symptoms and paranoid ideation in the elderly than previously reported, and these symptoms were associated with a poor prognosis.
据报道，老年人群中精神病性症状并不常见，在传统流行病学研究中可能被低估。
在瑞典哥德堡社区或机构中生活的85岁非痴呆个体的代表性样本（n = 347）中，通过精神病学和体格检查结果、关键 informant 访谈以及病历回顾来评估精神病性症状、躯体疾病、日常生活能力障碍和感觉障碍。对该样本进行为期3年的观察，记录精神病性症状、死亡率和新发痴呆情况。
任何精神病性症状的患病率为10.1%（’95%置信区间[CI]，7.1% - 13.7%）；幻觉为6.9%（95% CI，4.5% - 10.1%）；妄想为5.5%（95% CI，3.3% - 8.4%）。偏执观念的患病率为6.9%（95% CI，4.5% - 10.1%）。逐步逻辑回归分析显示，幻觉与重度抑郁综合征（优势比[OR]，3.9；95% CI，1.3 - 11.9）、日常生活能力障碍（OR，5.2；95% CI，1.8 - 14.9）以及视力缺陷（OR，3.4；95% CI，1.0 - 11.1）相关。妄想与日常生活能力障碍（OR，4.9；95% CI，1.8 - 13.3）相关。偏执观念与视力缺陷（OR，3.6；95% CI，1.2 - 10.5）和心肌梗死（OR，4.6；95% CI，1.7 - 12.6）相关。幻觉（OR，3.1；95% CI，1.4 - 6.8）、妄想（OR，2.9；95% CI，1.2 - 6.9）和偏执观念（OR，2.7；95% CI，1.2 - 6.2）均与85至88岁时痴呆发病率增加相关。幻觉和偏执观念与女性3年死亡率增加相关，而与男性无关。
我们发现老年人群中精神病性症状和偏执观念的患病率高于先前报道，且这些症状与不良预后相关。
