The authors describe the clinical course and the brain imaging findings of six patients with late age onset psychoses who were treated with electroconvulsive therapy (ECT). In all five patients who failed to respond to ECT, one or more structural brain changes (lateral ventricular enlargement and/or subcortical structural changes) were observed. In addition, all six patients developed an interictal ECT-induced delirium. Consistent with previous ECT-induced delirium studies, caudate hyperintensities were present in the three patients who received brain MRI scans. The potential clinical correlates of structural brain changes in LAOP patients will be described, along with proposed areas of future research.
KEY wows-Late onset psychosis, paraphrenia, depression. ECT.
Roth reintroduced the term 'paraphrenia' defining it as a syndrome characterized by a 'well organized system of paranoid delusions with or without auditory hallucinations existing in the setting of a well preserved personality and affective response. In the great majority of these patients the illness commences after the age of 60' (Roth, 1955). Since Roth's description, patients with late age onset psychoses (LAOP) have been increasingly recognized (Miller and Lesser, 1988). As knowledge has increased, it appears that a significant number of patients with LAOP may not respond satisfactorily to either antipsychotics or electroconvulsive therapy (ECT) (Kay and Roth, 1961; Botteron et al., 1991; Miller et al., 1991). In addition, LAOP patients may be at an increased risk for developing side-effects from antipsychotics compared with other patients (Yassa et al., 1986).
Recent studies using brain magnetic resonance imaging (MRI) and computerized axial tomography (CT) have reported an increased occurrence of basal ganglia and large deep white matter hyper-