[Screening for metabolic syndrome in older patients with severe mental illness]. / Metabole screening bij oudere patiënten met een ernstige psychiatrische aandoening1.

BACKGROUND: Diabetes, cardiovascular disease and metabolic syndrome are more prevalent in older patients with severe mental illness (smi) than in healthy older persons in the same age-group as the smi patients. Compared to the general population, smi patients are often in a poorer state of (physical) health and have a shorter life expectancy.
AIM: To assess the value of screening older smi patients (≥ 60) for metabolic syndrome.
METHOD: We performed a prospective evaluation of the metabolic screening outcome data relating to 100 older smi patients and 124 healthy older patients and compared the results.
RESULTS: In our smi patients (average age 69 years; 52% bipolar disorder, 48% schizophrenia) the frequency of metabolic syndrome (43%) was no higher than in healthy older persons (39.5%, p = 0.60). However, in 51% of the smi sample, metabolic screening detected at least one metabolic abnormality in a patient with no previous history for that specific parameter.
CONCLUSION: By making routine metabolic screening available to a greater number of older smi patients, we should be able to identify substantial numbers of metabolic abnormalities that have been previously overlooked.

Theory of Mind differences in older patients with early-onset and late-onset paranoid schizophrenia.

OBJECTIVE: Theory of Mind (ToM) is considered an essential element of social cognition. In younger schizophrenia patients, ToM impairments have extensively been demonstrated. It is not clear whether similar impairments can be found in older schizophrenia patients and if these impairments differ between older patients with early-onset and late-onset schizophrenia. METHODS: Theory of Mind abilities were assessed using the Hinting Task in 15 older patients (age 60 years and older) with early-onset paranoid schizophrenia, 15 older patients with late-onset paranoid schizophrenia and 30 healthy controls. ANCOVA was performed to test differences between groups. Analyses were adjusted for level of education. Effect sizes, partial eta squared (ε(2) ), were computed as an indication of the clinical relevance of the findings. RESULTS: Patients with early-onset schizophrenia scored significantly lower on the Hinting Task (mean 16.1; SD 4.3) compared with patients with late-onset schizophrenia (mean 18.6; SD 1.5) and with healthy controls (mean 19.0; SD 1.4). The effect size of this difference was large (ε(2) = 0.2). CONCLUSIONS: These results suggest that ToM functioning may be a protective factor modulating the age at onset of psychosis. Further studies into the relationship between social cognition and onset age of psychosis are warranted.

[Frontotemporal dementia and schizophrenia in later life: a comparison of executive and general cognitive functioning]. / Frontotemporale dementie en schizofrenie op oudere leeftijd: een verkenning van executief en globaal cognitief functioneren.

BACKGROUND: Frontotemporal dementia (FTD) is characterised clinically by progressive changes in behaviour and personality; these changes are followed by cognitive disorder. FTD needs to be differentiated from other forms of dementia and from psychiatric conditions such as schizophrenia. Both FTD and schizophrenia lead to cognitive disorders and particularly to executive impairments. AIM: To compare executive and general cognitive functioning in patients with FTD and in patients with schizophrenia in later life. METHOD: As cognitive screening instruments we used the 'Frontal Assessment Battery' (FAB) and the 'Mini-Mental State Examination' (MMSE). The FAB en MMSE test results (retrieved from the database of the Alzheimer centre of the VU medical centre) for 25 outpatients diagnosed as having FTD were compared with the test results (retrieved from the 'SOUL' study database) for 31 elderly schizophrenia patients. RESULTS: In both the fab and the MMSE tests the scores for the patients with FTD were significantly lower than the scores for the patients with schizophrenia. CONCLUSION: Our study suggests that, despite the clinical similarities, there are differences between patients with FTD and elderly patients with schizophrenia with regard to executive and general cognitive functioning. Further studies are needed in order to differentiate between the two illnesses.

[Elderly patients with schizophrenia: prevalence and distribution of age at onset in a psychiatric catchment area in Amsterdam]. / Ouderen met schizofrenie: prevalentie en verdeling naar ontstaansleeftijd in een psychiatrisch verzorgingsgebied in Amsterdam.

BACKGROUND: Elderly patients with schizophrenia are underrepresented in the literature on schizophrenia, although they constitute a rapidly growing group with specific characteristics. The Amsterdam-based study entitled 'Schizophrenia in Old Age' is currently examining the clinical and psychosocial functioning of a cohort of older patients with schizophrenia. AIM: To ascertain the one-year prevalence of schizophrenia and the distribution according to age at onset and gender in patients aged 60 years or over within a specific psychiatric catchment area. METHOD: The study is based on the case register of a Mental Health Organisation during 1-7-2007 to 30-6-2008. RESULTS: The one-year prevalence of schizophrenia was 0.55 % (95% ci: 0.46-0.64). In more than one in three patients the age of onset was 40 years or over. Women outnumbered men, even in the early-onset schizophrenia subgroup. CONCLUSION: We found the prevalence of schizophrenia among older persons to be comparable to the prevalence among younger populations. The considerable number of patients who developed schizophrenia at an advanced age and the preponderance of women are distinguishing features of older persons with schizophrenia.