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Brain atrophy is a frequent finding in elderly patients with first episode psychosis

  • Ulla-Marja Louhija (a1), Tuula Saarela (a2), Kati Juva (a1) and Björn Appelberg (a1)



To characterize the yearly incidence, diagnostic distribution, and neuro-radiologic findings in patients aged over 60 years, referred to psychiatric treatment with first episode psychosis (FEP).


A computerized search, including all patients referred to psychiatric treatment during 12 consecutive months with a de novo diagnosis of psychosis was performed in the Helsinki region catchment area with 1.2 million inhabitants. Diagnoses based on hospital records were made by a group of one neurologist and three psychiatrists. MRI- or CT scans performed as a part of routine clinical management were used when available.


107 patients (27 males and 80 females) with FEP were identified and categorized into four diagnostic groups: schizophrenia, delusional disorder, psychotic depression, and psychosis due to another medical condition. No patients with de novo onset mania were found. Psychosis due to another medical condition was the most common diagnosis. A high frequency of signs of cortical brain atrophy was seen in all diagnostic groups, while central atrophy was more frequent in patients with psychosis due to another medical condition than in the other groups.


Organic brain changes related to ageing or degenerative illnesses may be an etiologic factor in elderly patients with FEP.


Corresponding author

Correspondence should be addressed to: Björn Göran Appelberg, Psychiatry Centre, Helsinki University Hospital, PB 590, 00029 HUS, Finland. Phone: +358405482332; Fax: +358947163625. Email:


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Behdinan, T. et al. (2015). Neuroimaging predictors of functional outcomes in schizophrenia at baseline and 6-months follow-up. Schizophrenia Research, 169, 6975.
Benjamin, S. and Steffens, D. C. (2011). Structural neuroimaging of geriatric depression. Psychiatric Clinics of North America, 34, 423435.
Block, N. R. et al. (2016). Frontotemporal dementia and psychiatric illness. Emerging Clinical and Biological Links in Gene Carriers American Journal of Geriatric Psychiatry, 24, 107116.
Dotson, V. M., Davatzikos, C., Kraut, M. A. and Resnick, S. M. (2009). Depressive symptoms and brain volumes in older adults: a longitudinal magnetic resonance imaging study. Journal of Psychiatry & Neuroscience, 34, 367375.
Howard, R., Rabins, P. V., Seeman, M. V. and Jeste, D. V. (2000). Late-onset schizophrenia and very-late-onset schizophrenia like psychosis: an international consensus. The international Late-Onset Schizophrenia Group. American Journal of Psychiatry, 157, 172178.
Fazekas, F., Chawluk, J. B., Alavai, A., Hurtig, H. I. and Zimmerman, R. A. (1987). MR signal abnormalities at 1,5T in Alzheimers dementia and normal ageing. American Journal of Roentgenology, 149, 351356.
Lesser, I. M., Miller, B. J., Swartz, J. R., Boone, K. B., Mehringer, C. M. and Mena, I. (1993). Brain imaging in late-life schizophrenia and related psychosis. Schizophrenia Bulletin, 19, 773782.
Pose, M., Cetkovich, M., Gleichgerrcht, E., Ibáñez, A., Torralva, T. and Manes, F. (2013). The overlap of symptomatic dimensions between frontotemporal dementia and several psychiatric disorders that appear in late adulthood. International Review of Psychiatry, 25, 159167.
Resnick, S. M., Pham, D. L., Kraut, M. A., Zonderman, A. B. and Davatzikos, C. (2003). Longitudinal magnetic resonance imaging studies of older adults: a shrinking brain. Journal of Neuroscience, 23, 32953301.
Scheltens, P., Fox, N., Barkhof, F. and DeCarli, C. (2002). Structural magnetic resonance imaging in the practical assessment of dementia: beyond exclusion. Lancet Neurology, 1, 1321.
Seppälä, T., Louhija, U.-M., Appelberg, B., Herukka, S.-K. and Juva, K. (2014). Comparison between clinical diagnosis and CSF biomarkers of Alzheimer's disease in elderly patients with late onset psychosis – Helsinki old age psychosis study (HOPS). American Journal of Geriatric Psychiatry, 22, 908916.
Sexton, C. E., Mackay, C. E. and Ebmeier, K. P. (2013). A systematic review and metaanalysis of magnetic resonance imaging studies in late-life depression. American Journal of Geriatric Psychiatry, 21, 184195.
Snowden, J. S. et al. (2012). Psychosis, {C9ORF72} and dementia with Lewy bodies. Journal of Neurology, Neurosurgery and Psychiatry, 83, 10311032.
Solje, E. et al. (2015). The phenotype of the C9ORF72 expansion carriers according to revised criteria for bvFTD. PLoS ONE. 10, e0131817. doi: 10.1371/0131817.
Tilastokeskus -“Väestörakenne-tilasto. Available at
Woolley, J. D., Khan, B. K., Murthy, N. K., Miller, B. L. and Rankin, K. P. (2011). The diagnostic challenge of psychiatric symptoms in neurodegenerative disease: rates of and risk factors for prior psychiatric diagnosis in patients with early neurodegenerative disease. Journal of Clinical Psychiatry, 72, 126133.



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