An Initial Study of Modifiable and Non-Modifiable Factors for Late-Life Psychosis

Abstract

Objective To determine rates of psychotic symptoms and associated modifiable and non-modifiable factors among elderly long term nursing home residents without prior history of psychiatric illness. Method A cross-sectional design using the Scale for the Assessment of Positive Symptoms (SAPS) to measure psychotic symptoms, the Folstein’s Mini-Mental State Exam (MMSE), and Mattis Dementia Rating Scale (DRS) to evaluate cognitive impairment. Frequency and rates of global psychotic symptoms and hallucinations, delusions, formal thought disorder, and bizarre behavior were calculated. Logistic regression was used to examine modifiable (e.g., medication use) and non-modifiable clinical characteristics (e.g., older age) associated with late-life psychosis. Results There were 15.9% of subjects reporting delusions and 7.3% reporting hallucinations. History of stroke, poorer cognition, and receiving multiple medications showed significant association with late-life psychosis. Only stroke (OR = 9.12; 95% CI: 1.58-52.74) and receiving different classes of medications (benzodiazepines, neuroleptics, and antidepressants) (OR = 13.17; 95% CI: 2.10-85.82) remained significantly associated with psychosis after adjusting for Mattis DRS total score. Further analyses excluding subjects with MMSE scores of 24 or lower (n = 24) showed essentially the same results but subjects with better cognitive function suffered a less severe form of psychosis, essentially constituted by one symptom type (i.e., visual hallucinations). Conclusions Rates of late-life psychosis in this sample of nursing home residents without previous psychiatric history were high. Simultaneous use of medications including antidepressants, sedatives, and stimulants may be a clinically relevant modifiable factor to be targeted in prevention studies. Severity and type of psychosis is dependent on the severity of cognitive impairment.

Mental health of agricultural adolescents and adults: Preliminary results of a five-year study

“…A major strength of this study, as it continues, will be the application of the Family Stress Model, which has been well-examined and applied to various audiences including farm and rural families. The FSM remains a useful framework for conceptualizing the impact of economic pressure on farm adult and adolescent mental health, especially when considering economic challenges associated with farming remain a consistent and leading stressor among agricultural producers (2,5,6,8,63). The use of validated instruments to assess economic hardship, parenting styles and relationships, adult mental health, and adolescent mental health further strengthen the study.…”

“…Chronic stress has been associated with a myriad of mental health outcomes such as anxiety, depression, and substance use. The prevalence of common mental health conditions, specifically anxiety and depression, is consistently higher among adult farmers than the general population (5)(6)(7).…”

“…Cooperative Extension Services, United States Department of Agriculture (USDA), state departments of agriculture, non-profits, and health and safety professionals have organized efforts to address the growing concern. Research has estimated the prevalence of mental health conditions among the population and sub-populations (3,5,6,8,9). Mental health literacy programs have been developed and evaluated to increase self-efficacy among non-mental health professionals to respond to crises in rural and farm communities (10).…”

“…Similarly, there are recognized hazards in the agricultural environment, such as chemicals, gases, extreme climate conditions, physical hazards including noise, and zoonotic diseases which threaten the health of agricultural youth. While the work-related stressors and associated mental health outcomes among adult farmers are well-documented (5)(6)(7), and injuries to children well-examined (12,13), the mental health of farm adolescents is unknown.…”

Social Adaptive Functioning, Apathy, and Nondysphoric Depression among Nursing Home-Dwelling Very Old Adults

“…The sample of subjects examined in this study has been described in previous reports [32][33[34] and consisted of residents of rural nursing homes in the State of Iowa. The nursing homes considered for the present study were staffed by the University of Iowa Geriatric Psychiatry Division.…”