Search

Background: Several etiologies can underlie the development of late-onset psychosis, defined by first psychotic episode after age 40 years. Late-onset psychosis is distressing to patients and caregivers, often difficult to diagnose and treat effectively, and associated with increased morbidity and mortality. Methods: The literature was reviewed with searches in Pubmed, MEDLINE, and the Cochrane library. Search terms included “psychosis,” “delusions,” hallucinations,” “late onset,” “secondary psychoses,” “schizophrenia,” bipolar disorder,” “psychotic depression,” “delirium,” “dementia,” “Alzheimer’s,” “Lewy body,” “Parkinson’s, “vascular dementia,” and “frontotemporal dementia.” This overview covers the epidemiology, clinical features, neurobiology, and therapeutics of late-onset psychoses. Results: Late-onset schizophrenia, delusional disorder, and psychotic depression have unique clinical characteristics. The presentation of late-onset psychosis requires investigation for underlying etiologies of “secondary” psychosis, which include neurodegenerative, metabolic, infectious, inflammatory, nutritional, endocrine, and medication toxicity. In delirium, psychosis is common but controlled evidence is lacking to support psychotropic medication use. Delusions and hallucinations are common in Alzheimer’s disease, and hallucinations are common in Parkinson’s disease and Lewy body dementia. Psychosis in dementia is associated with increased agitation and a poor prognosis. Although commonly used, no medications are currently approved for treating psychosis in dementia patients in the USA and nonpharmacological interventions need consideration. Conclusion: The plethora of possible causes of late-onset psychosis requires accurate diagnosis, estimation of prognosis, and cautious clinical management because older adults have greater susceptibility to the adverse effects of psychotropic medications, particularly antipsychotics. Research is warranted on developing and testing efficacious and safe treatments for late-onset psychotic disorders.

Background:The ultimate goal of artificial intelligence (AI) is to develop technologies that are best able to serve humanity. This will require advancements that go beyond the basic components of general intelligence. The term “intelligence” does not best represent the technological needs of advancing society, because it is “wisdom”, rather than intelligence, that is associated with greater well-being, happiness, health, and perhaps even longevity of the individual and the society. Thus, the future need in technology is for artificial wisdom (AW).Methods:We examine the constructs of human intelligence and human wisdom in terms of their basic components, neurobiology, and relationship to aging, based on published empirical literature. We review the development of AI as inspired and driven by the model of human intelligence, and consider possible governing principles for AW that would enable humans to develop computers which can operationally utilize wise principles and result in wise acts. We review relevant examples of current efforts to develop such wise technologies.Results:AW systems will be based on developmental models of the neurobiology of human wisdom. These AW systems need to be able to a) learn from experience and self-correct; b) exhibit compassionate, unbiased, and ethical behaviors; and c) discern human emotions and help the human users to regulate their emotions and make wise decisions.Conclusions:A close collaboration among computer scientists, neuroscientists, mental health experts, and ethicists is necessary for developing AW technologies, which will emulate the qualities of wise humans and thus serve the greatest benefit to humanity. Just as human intelligence and AI have helped further the understanding and usefulness of each other, human wisdom and AW can aid in promoting each other’s growth

Background:Aging is associated with numerous stressors that negatively impact older adults’ well-being. Resilience improves ability to cope with stressors and can be enhanced in older adults. Senior housing communities are promising settings to deliver positive psychiatry interventions due to rising resident populations and potential impact of delivering interventions directly in the community. However, few intervention studies have been conducted in these communities. We present a pragmatic stepped-wedge trial of a novel psychological group intervention intended to improve resilience among older adults in senior housing communities.Design:A pragmatic modified stepped-wedge trial design.Setting:Five senior housing communities in three states in the US.Participants:Eighty-nine adults over age 60 years residing in independent living sector of senior housing communities.Intervention:Raise Your Resilience, a manualized 1-month group intervention that incorporated savoring, gratitude, and engagement in value-based activities, administered by unlicensed residential staff trained by researchers. There was a 1-month control period and a 3-month post-intervention follow-up.Measurements:Validated self-report measures of resilience, perceived stress, well-being, and wisdom collected at months 0 (baseline), 1 (pre-intervention), 2 (post-intervention), and 5 (follow-up).Results:Treatment adherence and satisfaction were high. Compared to the control period, perceived stress and wisdom improved from pre-intervention to post-intervention, while resilience improved from pre-intervention to follow-up. Effect sizes were small in this sample, which had relatively high baseline resilience. Physical and mental well-being did not improve significantly, and no significant moderators of change in resilience were identified.Conclusion:This study demonstrates feasibility of conducting pragmatic intervention trials in senior housing communities. The intervention resulted in significant improvement in several measures despite ceiling effects. The study included several features that suggest high potential for its implementation and dissemination across similar communities nationally. Future studies are warranted, particularly in samples with lower baseline resilience or in assisted living facilities.

Objectives:The relationship between wisdom and fluid intelligence (Gf) is poorly understood, particularly in older adults. We empirically tested the magnitude of the correlation between wisdom and Gf to help determine the extent of overlap between these two constructs.Design:Cross-sectional study with preregistered hypotheses and well-powered analytic plan (https://osf.io/h3pjx).Setting:Memory and Aging Center at the University of California San Francisco, located in the USA.Participants:141 healthy older adults (mean age = 76 years; 56% female).Measurements:Wisdom was quantified using a well-validated self-report-based scale (San Diego Wisdom Scale or SD-WISE). Gf was assessed via composite measures of processing speed (Gf-PS) and executive functioning (Gf-EF). The relationships of SD-WISE scores to Gf-PS and Gf-EF were tested in bivariate correlational analyses and multiple regression models adjusted for demographics (age, sex, and education). Exploratory analyses evaluated the relationships between SD-WISE and age, episodic memory performance, and dorsolateral and ventromedial prefrontal cortical volumes on magnetic resonance imaging.Results:Wisdom showed a small, positive association with Gf-EF (r = 0.181 [95% CI 0.016, 0.336], p = .031), which was reduced to nonsignificance upon controlling for demographics, and no association with Gf-PS (r = 0.019 [95% CI −0.179, 0.216], p = .854). Wisdom demonstrated a small, negative correlation with age (r = −0.197 [95% CI −0.351, −0.033], p = .019), but was not significantly related to episodic memory or prefrontal volumes.Conclusions:Our findings indicate that most of the variance in wisdom (>95%) is unaccounted for by Gf. The independence of wisdom from cognitive functions that reliably show age-associated declines suggests that it may hold unique potential to bolster decision-making, interpersonal functioning, and other everyday activities in older adults.

Positive psychiatry is the science and practice of psychiatry that focuses on psycho-bio-social study and promotion of well-being and health through enhancement of positive psychosocial factors (such as resilience, optimism, wisdom, and social support) in people with illnesses or disabilities as well as the in community at large (Jeste and Palmer, 2015). It is based on the principles that there is no health without mental health and that mental health can be improved through preventive, therapeutic, and rehabilitative interventions to augment positive psychosocial factors. Positive psychiatry is not a naïve, feel-good pseudoscience that views the world through rose-colored glasses. It is an evidence-based approach to understanding normal behavior as well as psychopathology and to improving well-being by measuring and enhancing positive psychosocial factors (Jeste et al., 2015).

Objective:Wisdom is a complex trait, and previous research has identified several components of wisdom. This study explored the possible impact of a diagnosis of a terminal illness on the conceptualization and evolution of wisdom while facing the end of life.Design and Participants:Semi-structured qualitative interviews were conducted with 21 hospice patients aged 58–97 years who were in the last six months of their life.Methods:Hospice patients were asked to describe the core characteristics of wisdom, as well as how their terminal illness might have impacted their understanding of this concept. The interviews were audiotaped, transcribed, and coded by the research team using a grounded theory analytic approach based on coding consensus, co-occurrence, and comparison.Results:Broad concepts of wisdom described by the hospice patients align with the extant literature, thereby supporting those general conceptualizations. In addition, hospice patients described how their life perspectives shifted after being diagnosed with a terminal illness. Post-illness wisdom can be characterized as a dynamic balance of actively accepting the situation while simultaneously striving for galvanized growth. This delicate tension motivated the patients to live each day fully, yet consciously plan for their final legacy.Conclusion:The end of life offers a unique perspective on wisdom by highlighting the modulation between actively accepting the current situation while continuing the desire to grow and change at this critical time. This paradox, when embraced, may lead to even greater wisdom while facing one's own mortality.

It is a great honor and a privilege to be appointed as the new Editor-in-Chief of theInternational Psychogeriatrics(IPG), the flagship journal of the premier international geriatric psychiatry organization – the International Psychogeriatric Association (IPA). I am a proud Life Member of the IPA, and have been involved in different activities of the IPA over the past three decades.

Background: There is currently a lack of consensus on the definition of successful aging (SA) and existing implementations have omitted constructs associated with SA. We used empirical methods to develop a dimensional model of SA that incorporates a wider range of associated variables, and we examined the relationship among these components using factor analysis and Bayesian Belief Nets.Methods: We administered a successful aging questionnaire comprising several standardized measures related to SA to a sample of 1948 older women enrolled in the San Diego site of the Women's Health Initiative study. The SA-related variables we included in the model were self-rated successful aging, depression severity, physical and emotional functioning, optimism, resilience, attitude towards own aging, self-efficacy, and cognitive ability. After adjusting for age, education and income, we fitted an exploratory factor analysis model to the SA-related variables and then, in order to address relationships among these factors, we computed a Bayesian Belief Net (BBN) using rotated factor scores.Results: The SA-related variables loaded onto five factors. Based on the loading, we labeled the factors as follows: self-rated successful aging, cognition, psychosocial protective factors, physical functioning, and emotional functioning. In the BBN, self-rated successful aging emerged as the primary downstream factor and exhibited significant partial correlations with psychosocial protective factors, physical/general status and mental/emotional status but not with cognitive ability.Conclusions: Our study represents a step forward in developing a dimensional model of SA. Our findings also point to a potential role for psychiatry in improving successful aging by managing depressive symptoms and developing psychosocial interventions to improve self-efficacy, resilience, and optimism.

Patients with dementia may be treated with several drugs because of comorbid conditions or symptoms related to the dementia itself. Such drug treatment can complicate patient management because many drugs may cause side effects, such as depression and Parkinsonism, that also are considered behavioral disturbances of dementia. Distinguishing between drug side effects and behavioral problems is difficult but necessary for several reasons. Attributing the behavioral disturbance to an incorrect cause can affect the type of treatment selected and the patient's response to it. It also can increase the overall cost of care and adversely affect the patient's quality of life. Making this distinction has theoretical importance as well, including the development of new drugs that have fewer behavioral side effects.

There is a paucity of research that examines the role of family members and friends in the lives of older schizophrenia patients. This study compared 66 middle-aged and elderly outpatients with 31 normal comparison subjects. Five dimensions of social network were assessed: (a) family composition, geographic proximity, and frequency of contact; (b) instrumental support; (c) emotional support and interpersonal difficulties; (d) role of friends; and (e) use of formal service providers as sources of support and assistance. As compared with normal subjects, the schizophrenia patients were less likely to be married, less likely to have children, more likely to live alone, and had fewer friendships. The patients were, however, similar to comparison subjects on the following family-relationship variables: frequency of contact, instrumental support received, presence of a family confidant, and extent of interpersonal difficulties. These findings do not support the stereotype of older schizophrenia patients as being estranged from family members. The need for developing interventions that use key family members to interface with service providers and to monitor treatment compliance and continuity of care is discussed.

When an ideal drug for any medical condition is sought, both its efficacy and safety need to be examined. For the treatment of the complex of symptoms that constitute the behavioral and psychological symptoms of dementia (BPSD), much of the literature has focused on antipsychotic agents, including both types of D2 blockers: the conventional neuroleptics and the newer atypical agents. Fewer studies have investigated other medications, such as anticonvulsants, benzodiazepines, betablockers, selective serotonin reuptake inhibitors, and cholinergics.

Objective There are few studies of successful aging in China. This study was designed to investigate the distribution, and related factors, of successful aging in an elderly Chinese population. Methods A cross-sectional, community-dwelling elderly population was surveyed in Shanghai, China. We defined successful aging based on a multi-dimensional model. Correlates of successful aging were explored through the Shanghai Successful Aging Project Questionnaire, which includes sociodemographic questions, and a battery of standardized instruments, including the Chinese version of the Mini-mental State Examination, activities of daily living, and the Life Satisfaction Index A (LSIA). Results The rate of successful aging was 46.2% [95% confidence interval (CI) 43.6-48.7] among people aged 65 or above, and the rate for males was higher than that for females. The rate was much lower for those aged 85 years or over (9.4%). Logistic regression analysis suggested that female gender and older age were unfavorable factors for successful aging. A higher score on the LSIA, more leisure activities and being currently married related to successful aging. Conclusion The rate of successful aging in Shanghai, China is similar to that found in studies from western countries. There are some potentially modifiable factors that may relate to successful aging.