Resistant late-onset schizophrenia with prominent neurocognitive deficits-Diagnostic dilemma and the role of Electroconvulsive therapy: A Case Series

摘要: Late-onset psychosis (LOP) denotes a distinct group of psychosis that begins after 45 years and can manifest as paraphrenia, schizophrenia-like psychotic disorder, or affective psychosis in the absence of any attributable cerebral pathology or dementia (Tampi et al. 2019). It commonly denotes late-onset schizophrenia (LOS), which predominantly presents with paranoid delusions, less negative symptoms, formal thought disorder, and variable neurocognitive deficits.(Vahia & Cohen 2009) A higher incidence of this disorder is seen in females, particularly with sensory deficits and social deprivation.(Tampi et al. 2019) Unlike the classical Kraepelinian description of dementia praecox, LOS usually responds well to low doses of antipsychotics (Vahia & Cohen 2009), with rare reports of severe pharmaco-nonresponsive symptoms and prominent neurocognitive deficits.(Tampi et al. 2019) Furthermore, in elderly patients at risk of extrapyramidal symptoms (EPS) and tardive dyskinesia (TD), the emergence of antipsychotic resistance can create further treatment hurdles necessitating somatic therapies.(Tampi et al. 2019) ECT is a safe and effective somatic treatment option across all age groups, with interestingly higher response rates in the elderly compared to the younger age group (73% vs 54%). But, medical comorbidities and the risk of neurocognitive deficits can frequently interfere with the decision to use ECT in the elderly population. However, ECT may be considered in the context of medication resistance or intolerance or acute exacerbations of illness.(Wilkins et al. 2008) In this report, we intend to reflect on the diagnostic and treatment …