SUMMARYOne hundred patients referred to old age psychiatry services in the West Midlands and 25 patients referred to a memory clinic in Bristol with mild to moderate dementia were assessed using the GMSMAS schedule together with a detailed inventory to assess their psychotic symptoms. On careful evaluation one patient did not have dementia. Eighty-three of the other 124 patients (66.9%) had at least one psychotic symptom. The prevalence of psychotic symptoms in the patients from the West Midlands and from the memory clinic in Bristol were extremely similar. Thirty-five per cent had at least one visual hallucination, 12.9% had at least one auditory hallucination, 48.4% had at least one delusional belief and 29.0% had at least one delusional misperception. Most individuals experienced their psychotic symptoms at a frequency between weekly and daily. Twenty-four had no insight into their psychotic symptoms and acted upon them, while only one patient had full insight into their symptoms. Thirty-seven subjects were mildly distressed and 14 were severely distressed by the psychotic symptoms they experienced. There was a trend for patients with cortical Lewy body dementia to be more likely to have psychotic symptoms than patients with Alzheimer's disease or vascular dementia. The symptom profile of psychotic symptoms in the different dementias was, however, very similar. The frequencies of individual psychotic symptoms are described in the text.KEY WORDS-psychotic symptoms; dementia; phenomenology With the increased attention paid to psychotic symptoms in dementia sufferers over the last decade, it appeared that a consensus was developing that between 30 and 45% of dementia sufferers experienced these symptoms (Cummings et al., 1987;Cooper et al., 1991;Burns et al., 1990;Sultzer et al.,

The survey aims to evaluate psychiatric morbidity in the carers of dementia sufferers using a semi-structured psychiatric interview. The case notes of consecutive referrals to four psychiatric services for the elderly in the West Midlands and a memory clinic service in Bristol were reviewed. All referrals who fulfilled the CAMDEX criteria for mild or moderate dementia and had a carer in contact at least once a week were contacted. Participants were assessed using a detailed package which included a Geriatric Mental State Schedule for the carers. More than 90% of those contacted agreed to participate. Altogether 125 patients with dementia were assessed of whom 109 had family members or friends as the main carer. Thirty-one (28.4%) of the carers had a case level of depression and three (2.75%) had a case level of anxiety. In addition, 36 (33.2%) carers had subcase levels of morbidity. First-degree relatives showed a trend to be more likely to suffer from depression than friends or more distant relatives. The prevalence of depression was similar among carers in the two different service settings. There was good agreement between AGECAT and RDC diagnosis of depression.

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Eighty-seven out of a clinical cohort of 124 patients with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) dementia were followed up at monthly intervals for 1 year. Psychotic symptoms were assessed using the Burns's Symptom Checklist, and cognitive functioning was evaluated with the CAMCOG. The annual incidence rate of psychotic symptoms was 47%, although many of the incident symptoms lasted less than 3 months. Fifty-three percent of patients with psychosis experienced resolution of their symptoms. Patients either experienced brief or persistent psychotic disorders, with few having an intermediary course. Persistent psychosis was significantly associated with a 3-month duration of symptoms at baseline. Neuroleptics did not significantly influence the course of psychotic symptoms.

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