blue_ocean

Old age psych - confusing question/answer

5 posts in this topic

An elderly lady reports smelling of gas passed through the walls and thought her neighbours are trying to poison her. She has contacted the police on a number of occasions over last 3 months claiming that neighbours are spying on her. The most likely diagnosis is;
Select one:
Delusional disorder
Diogenes syndrome
Schizophrenia
Alzheimer's disease 

 

A 70-year-old man reports hearing 'burglar noises' in his attic every night. He believes that his neighbours are spying on him and are planning a 'coup' to evacuate him from his bungalow. He seems depressed due to this problem but has no somatic signs. The most likely cause of such a late-onset psychosis is
Select one:
Alzheimer's dementia 
Paranoid personality disorder
Very late onset schizophrenia
Late onset schizophrenia
Substance misuse

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@mustafa The first one - answer is given Schizophrenia. Explanation: Late-onset schizophrenia is characterized by paranoid delusions and hallucinations. The patients usually complain of partition delusions as described above and may harbour persecutory delusions against neighbours. Social isolation and sensory deprivation are significant contributory factors for psychosis in the elderly. Confusingly, ICD-10 includes paraphrenia along with paranoid schizophrenia, and also includes the term paraphrenia with delusional disorders. In the presence of hallucinations, schizophrenia is the most appropriate diagnosis - This is understandable. 

But the second question: Answer is given Alzheimer's Dementia. Explanation: The most common cause of late onset psychosis is Alzheimer's disease!! 

Any thoughts to clarify these 'man made' self contradictory statements? 

Edited by blue_ocean
More info

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Hi

In both cases, in a clinical setting, wouldn't you be looking to rule out dementia? late onset schizophrenia/vlosp are much rarer than alzheimer's is. If the stem doesn't explicitly say that the cognitive assessment has come back normal, I'd pick alzheimer's. 

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On 12/9/2015 at 03:31, blue_ocean said:

An elderly lady reports smelling of gas passed through the walls and thought her neighbours are trying to poison her. She has contacted the police on a number of occasions over last 3 months claiming that neighbours are spying on her. The most likely diagnosis is;
Select one:
Delusional disorder
Diogenes syndrome
Schizophrenia
Alzheimer's disease 

 

A 70-year-old man reports hearing 'burglar noises' in his attic every night. He believes that his neighbours are spying on him and are planning a 'coup' to evacuate him from his bungalow. He seems depressed due to this problem but has no somatic signs. The most likely cause of such a late-onset psychosis is
Select one:
Alzheimer's dementia 
Paranoid personality disorder
Very late onset schizophrenia
Late onset schizophrenia
Substance misuse

First question has not mentioned about cognitive impairment so diagnosis should be delusional disorder (persecutory type).

Second question answer would be Dementia. Because most common cause of psychosis in elderly is Dementia.

Edited by mania

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