Psych Vivas · Old age psychiatry — psychosis
Late-onset psychosis — structured clinical viva
Fellowship viva covering Howard consensus, partition delusions, organic exclusion, DLB trap, low-dose antipsychotic, Schneider mortality framing, and cognitive surveillance.
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FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the old-age psychiatry registrar. A 79-year-old woman with progressive hearing loss presents with six months of partition delusions, third-person voices, and neighbour conflict. Family worry she has 'Alzheimer's'. Discuss definition of LOS/VLOSLP, formulation including sensory factors, organic work-up, differentials (especially dementia and DLB), antipsychotic choice with dosing and dementia mortality caution, risk, capacity, and follow-up.
Opening move
State you will structure: risk and capacity → definitions → formulation → differentials → work-up → treatment (non-drug then drug) → dementia caution → follow-up. Do not launch into a drug name before safety and organic exclusion.[1][3]
References7ShowHide
- [1]Howard R, Rabins PV, Seeman MV, Jeste DV Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus Am J Psychiatry, 2000.PMID 10671383
- [2]Howard R, Almeida O, Levy R Phenomenology, demography and diagnosis in late paraphrenia Psychol Med, 1994.PMID 8084935
- [3]Kim K, Jeon HJ, Myung W, et al. Clinical Approaches to Late-Onset Psychosis J Pers Med, 2022.PMID 35330384
- [4]Schneider LS, Dagerman KS, Insel P Risk of death with atypical antipsychotic drug treatment for dementia JAMA, 2005.PMID 16234500
- [5]Kanemoto H, Satake Y, Suehiro T, et al. Characteristics of very late-onset schizophrenia-like psychosis as prodromal dementia with Lewy bodies Alzheimers Res Ther, 2022.PMID 36138485
- [6]Scott J, Greenwald BS, Kramer E, Shuwall M Atypical (second generation) antipsychotic treatment response in very late-onset schizophrenia-like psychosis Int Psychogeriatr, 2011.PMID 21118614
- [7]Ray WA, Chung CP, Murray KT, et al. Atypical antipsychotic drugs and the risk of sudden cardiac death N Engl J Med, 2009.PMID 19144938