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There is controversy about whether late-onset schizophrenia is a precursor of cognitive decline.
To examine the long-term outcome of a group of patients with late-onset schizophrenia.
Patients with onset of DSM–III–R schizophrenia at age 50 years or over, but without dementia, and a healthy control group were assessed at baseline (n=27 and n=34, respectively), after 1 year and after 5 years (n=19 and n=24, respectively) on measures of psychopathology, cognition and general functioning, and compared on rates of decline and incidence of dementia.
Nine patients with late-onset schizophrenia and none of the control group were found to have dementia (5 Alzheimer type, 1 vascular, 3 dementia of unknown type) at 5-year follow-up. There appeared to be a subgroup of late-onset schizophrenia patients without signs of dementia at baseline or at 1 year follow-up who subsequently declined.
Late-onset schizophrenia may be a prodrome of Alzheimer-type dementia. More longitudinal studies are required to determine its nosological status.
This chapter explores the nature of somatisation, describes the epidemiology, and outlines research and clinical issues. Psychiatric classification systems have included the specific disorder of somatization, as well as other disorders of unknown prevalence and questionable validity. Other important categories from a clinical perspective, such as chronic pain disorder, have major impacts on health care utilization across a wide range of disciplines. The vulnerability to somatic distress is not likely to occur simply secondarily to a general liability to the common forms of anxiety and depression. Primary psychogenic pain disorder is relatively rare. The avoidance response to pain often results in complex and even bizarre pain behaviors which are relatively common in pain-unit patients. Patients are particularly unlikely to comply with cognitive-behavioral approaches if they feel that such strategies will just result in their symptoms worsening, unless the physician also provides relevant symptom relief.
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