Pseudodementia in Schizophrenia and Mania

Abstract

The importance of differentiating depressive pseudodementia from true dementia seems to be well recognized by psychiatrists, yet there seems less recognition that other functional psychoses in the elderly can present with symptoms of cognitive impairment. In this report, we describe two patients--one suffering from late onset schizophrenia and one from a manic illness--who were diagnosed as suffering from dementia in the early stages of their illnesses. We discuss some of the difficulties in making diagnoses in these cases which include an historical tendency for clinicians, including psychiatrists, to assume an organic aetiology for first presentation psychoses in old age. Although the concept of pseudodementia has been criticised in recent years, we conclude that it retains its clinical utility in that it orientates the clinician to the importance of recognizing treatable functional psychoses in the elderly.

Pseudodementia in Patients with Unipolar and Bipolar Disorders: A Case Series and Literature Review

“…As a matter of fact, all patients with BD and pseudodementia in our sample showed psychomotor retardation during the depressive phases. On the contrary, consistent with previous reports, in BD patients with pseudodementia in our case series, psychotic symptoms are not necessarily present [ 30 , 31 , 32 , 35 , 37 , 39 , 40 , 42 , 43 , 44 ].…”

“…In approximately two-thirds of patients, pseudodementia features occurred during a depressive episode (19 of 30, 63%) [ 9 , 30 , 32 , 35 , 36 , 37 ]. However, pseudodementia has also been described in seven patients with manic or mixed episodes [ 9 , 38 , 39 , 40 , 41 , 42 , 43 ] and in one patient diagnosed with a depressive mixed state [ 44 ]. Severe impairment of attention and short-term memory during a whole manic-depressive cycle was reported in one patient [ 31 ], while another with pseudodementia features during mixed mania also experienced depressive pseudodementia during follow-up [ 42 ].…”

“…Psychomotor disturbances and psychotic symptoms were common, being respectively reported in twelve [ 31 , 32 , 36 , 37 , 38 , 39 , 40 , 42 , 43 , 44 ] and seven cases [ 30 , 32 , 35 , 39 , 43 , 44 ]. Most cases presented with disorientation, attention, and short-term memory impairments.…”

“…Most cases presented with disorientation, attention, and short-term memory impairments. Fluctuations of affective and/or cognitive symptoms were sometimes noted [ 39 , 43 , 44 ], making the differential diagnosis of delirious mania difficult. Non-specific electroencephalogram (EEG) abnormalities were found in about one-third of patients (8 of 22, 36%) [ 9 , 32 , 36 , 37 , 38 , 40 , 41 ].…”

“…ECT was used in more than half of patients (11 of 22, 50%) [ 29 , 32 , 36 ], including one patient who had been previously treated effectively with a combination of venlafaxine, mirtazapine, and aripiprazole but repeatedly relapsed [ 44 ] and one patient who had not improved after being treated with antidepressants, antipsychotics, and even lithium [ 36 ]. While most of these cases were diagnosed with major depression with or without mixed features, lithium was preferentially used in manic patients (8 of 22, 36%) [ 31 , 38 , 39 , 41 , 42 , 45 , 46 ]. In addition, one patient with depressive pseudodementia was effectively treated with nortriptyline [ 35 ].…”