Kim Kiwon, Jeon Hong Jin, Myung Woojae, Suh Seung Wan, Seong Su Jeong, Hwang Jae Yeon, Ryu Je Il, Park Seon-Cheol
Department of Psychiatry, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 05355, Korea.
Department of Psychiatry, Depression Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
J Pers Med. 2022 Mar 2;12(3):381. doi: 10.3390/jpm12030381.
Psychosis can include schizophrenia, mood disorders with psychotic features, delusional disorder, active delirium, and neurodegenerative disorders accompanied by various psychotic symptoms. Late-onset psychosis requires careful intervention due to the greater associated risks of secondary psychosis; higher morbidity and mortality rates than early-onset psychosis; and complicated treatment considerations due to the higher incidence of adverse effects, even with the black box warning against antipsychotics. Pharmacological treatment, including antipsychotics, should be carefully initiated with the lowest dosage for short-term efficacy and monitoring of adverse side effects. Further research involving larger samples, more trials with different countries working in consortia, and unified operational definitions for diagnosis will help elaborate the clinical characteristics of late-onset psychosis and lead to the development of treatment approaches.
精神病可包括精神分裂症、伴有精神病性特征的心境障碍、妄想性障碍、急性谵妄以及伴有各种精神病性症状的神经退行性疾病。迟发性精神病需要谨慎干预,因为其继发精神病的相关风险更高;发病率和死亡率高于早发性精神病;并且由于不良反应发生率较高,即使有抗精神病药物的黑框警告,治疗考虑也很复杂。包括抗精神病药物在内的药物治疗应以最低剂量谨慎启动,以实现短期疗效并监测不良反应。进一步的研究,包括更大样本量、不同国家联合开展更多试验以及统一的诊断操作定义,将有助于阐明迟发性精神病的临床特征,并推动治疗方法的发展。