Harvard Medical, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Harv Rev Psychiatry. 2011 Jul-Aug;19(4):190-7. doi: 10.3109/10673229.2011.599184.
The etiology of new psychotic symptoms in late life, including subtle changes in cognition, is a controversial emerging area of study. The development of psychotic symptoms, particularly paranoia, is a common occurrence in late life, and the symptoms of cognitive dysfunction and psychosis are often prominent in dementia, schizophrenia, and mood disorders. This intermixing of symptoms has inescapably led to diagnostic confusion with regard to elderly patients with new-onset psychosis. The complex relationship among different domains of psychopathology makes it difficult to tease apart disorders of affect from psychosis, affect from cognition, and psychosis from cognition. It is therefore potentially useful to modify and expand our approach to how we conceptualize these patients. Emerging evidence suggests that those with dementia, psychotic disorders, and mood disorders suffer from growing cognitive deficits. The article suggests that deficits in social cognition, in particular, may be the unifying deficit that helps to explain why heterogeneous patients may develop paranoia and psychotic symptoms in late life.
老年期新发精神病症状（包括认知方面的细微变化）的病因是一个颇具争议的新兴研究领域。精神病症状，尤其是妄想，在老年期很常见，认知功能障碍和精神病的症状在痴呆、精神分裂症和心境障碍中也很突出。这些症状的相互混合不可避免地导致了新发精神病老年患者的诊断混淆。不同精神病理学领域之间的复杂关系使得很难区分情感障碍与精神病、情感与认知以及精神病与认知。因此，修改和扩展我们对这些患者的概念化方法可能是有用的。新出现的证据表明，痴呆、精神病和心境障碍患者的认知缺陷在不断增加。该文章表明，社会认知缺陷，尤其是可能是统一的缺陷，可以帮助解释为什么不同的患者在老年期可能会出现妄想和精神病症状。
