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Thesis

French

ID: <

http://hdl.handle.net/20.500.11794/22454

>

Where these data come from
Clinical and cognitive characterisation of late onset psychotic disorders

Abstract

Psychotic symptoms are commonly observed among older customers. Although it has a direct impact on care and treatment, the identification of their etiology often remains difficult and uncertain, especially when these events occur for the first time in old age. Are these primary symptoms of late psychopathology or secondary symptoms of an underlying neurodegenerative, neurological or medical condition? Although studies have been carried out with the aim of characterising psychotic disorders of late occurrence and whether or not to provide nosological validation of the concept of schizophrenia at late start, the results of this work remain fragmented and controversial. Five chapters addressing each of the well-defined objectives make up this doctoral work. Chapter I is first a general introduction to the problem of early schizophrenia (SDP: 40, 45, 50, 60 years depending on studies). Chapter II presents the results of a retrospective study of medical records, which concludes in particular that there is a low prevalence of late onset psychotic disorders (TPT: > 40 years) and very late (TPTT: > 60 years) in addition to showing little distinctive features of these two nosological entities proposed by an International Late-Onset schizophrenia Group in 2000. Chapter III reports the results of the monitoring study to characterise clinical and symptomatic profiles of older patients with late psychotic symptoms (TPS: > 50 years) and early schizophrenia (SDP: < 40 years). The comparison of 17 individuals with SPT and 17 patients with SDP suggests some socio-demographic and medical differences between these two groups of patients currently well controlled at psychiatric level (few active positive symptoms and some residual negative symptoms). Some differences in past positive and negative symptoms patterns are highlighted, but these are difficult to interpret due to a lack of equivalence of the past period between groups. Chapter IV reports the data from the monitoring study to characterise the cognitive profile and natural evolution of subjects with SPT and SDP. The results suggest heterogeneous cognitive profiles, possibly characterised by executive deficits and monetic fragility in several individuals with SPT. On the other hand, an increased adverse trend cannot be assumed with certainty in CPS subjects, but there are indications of potential vascular/neurodegenerative vulnerability in a subgroup of patients. Finally, Chapter V analyses and criticises all the data collected in the context of this thesis and also discusses the clinical implications/perspectives and associated future research.

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