Follow up of late onset psychosis

Abstract

This study was done to understand various factors influencing the compliance, outcome and follow up of patients with late onset psychosis (LOP- Age of onset > 60years). The emergence of psychotic symptoms for the first time in later life poses a diagnostic challenge for clinicians assessing and treating elderly persons with mental illness. Late or very late onset psychosis (LOP) has not been well studied and various treatment issues remain unresolved. The incidence of psychosis increases with age with no. of factors leading to increase in vulnerability and expression.  This article reviews various factors influencing the follow up. In this study we reviewed all the charts of the patients diagnosed as late onset psychosis (age>60years) {ICD 10 category of F20-29}, evaluated is psychiatric services of CIMS treated both in OP care and IP care. Patients were reviewed between the time period of December 2015 to December 2017 (2 years) and followed up. Relevant sociodemographic and clinical variables like compliance, number of follow ups were collected, coded, entered and analyzed. 36 patients met the criteria and they were systematically analyzed. A total of 36 patients with late onset psychosis presented with mean age of 71.6 years of which 47.2 were females. Paranoid schizophrenia was the commonest type of psychosis (44.4%).  41.6% had good compliance. 38.89% did not come for follow up. It was observed, literates had come for more no. of follow ups. Interestingly, illiterates [n-18] had a better compliance [n-7]. It was also observed that patients with shorter duration of illness [n-7] had a good compliance. Quetiapine had a better compliance (16.6%) with maximum response (13.89%). It is observed that follow up is poor even in severe mental illness like LOP. Social factors like literacy and socioeconomic status seemed to influence follow up. Social factors and type of drugs seemed to influence compliance. Clinical improvement was good with quetiapine and resperidone. Efforts to improve follow up and compliance should be made even in the first contact especially in poor and illiterate patients. Quetiapine may be the drug of choice in LOP to enhance compliance and improvement. Though psychosis is becoming more common in elderly, compliance still remains an issue with good compliance being less  than  50%  and majority of  them  never  turned  up  for  follow  up.  Compliance can be improved by supervised medication, educating the patient about the side-effects and the need for regular follow up.