At the meeting, in response to an audience question as to whether the female predominance in late-life psychosis could be related to estrogen withdrawal, Dr. Howard replied that he thought it unlikely, since the peak incidence of the psychosis in women doesn't come until 3 decades after menopause.
“I think the difference has much more to do with the ways in which the dopamine system in males and females ages. Parkinson's disease is one and a half times more common in men than women. Psychosis and Alzheimer's disease are twice as common in women as men.
“So it seems that dopa-excess disorders are commoner in older women, and dopa-deficiency disorders are commoner in men,” he observed.
Dr. Howard declared having no financial conflicts.
Dr. Robert Howard emphasizes a conservative approach to prescribing antipsychotics in the elderly.
My Take
Change in Thinking Long Overdue
What this discussion highlights is that we need to pay much more attention to psychoses in older persons. This is important for caregivers as well as for persons affected themselves. Many researchers and clinicians still think that psychoses are very rare among elderly persons. The time to change this thinking is long overdue. It has very important public health implications, because older persons are an ever-increasing proportion of the population in the United States and other high-income countries.
EZRA S. SUSSER, M.D., DR.P.H., is professor of psychiatry and epidemiology at the Mailman School of Public Health, Columbia University, New York.
