A Case of Very-late-onset Schizophrenia-like Psychosis
The patient is a 67-year-old Korean woman with no previous history of psychiatric problems serious enough to require psychiatric treatment. She had been an active female shaman for more than 30 years, but this work had not affected her judgment or reality. No one in her family had received medical services from the psychiatric department, and alcohol abuse was not suspected. With the exception of behaviors manifested during the performance of exorcisms, the patient did not exhibit improper behavior or elevated mood; therefore, a mood disorder could not be diagnosed.\nIn October 2009, she was diagnosed with buccal cancer and underwent oral cavity excision surgery. After the operation, adjuvant radiation therapy was recommended, but she refused further treatment due to a rumor that radiation therapy causes great harm. Unfortunately, in January 2010, pain in the oral cavity was aggravated, and she became anxious about dying from cancer. At the same time, she began to hear a male voice whispering about her every movement and developed a persecutory idea that neighbors would steal her house after her death.\nWhen she visited the Psychiatry Department in July 2010, she complained of auditory hallucinations in the form of voices about her movements. She reported that several cameras in her house watched her and that she would be killed by neighbors while she was sleeping. Based on these reports, we suggested hospitalization for close observation and correct diagnosis.\nDuring the patient's psychiatric interview, she reported auditory hallucinations, ideas of reference, and persecutory delusions. No abnormalities emerged from a physical examination, a blood test, or electroencephalography. The brain MRI showed mildly diffuse brain atrophy ().\nNeuropsychological testing was difficult to complete due to the patient's inattention and evasiveness. shows the results of the patient's neuropsychological assessment. The results of the Korean Consortium to Establish a Registry for Alzheimer's Disease assessment (CERAD-K; ) did not meet criteria for cognitive impairment.\nIn summary, we diagnosed this patient with VLOSLP on the basis of her psychotic symptoms and test results.,\nThe patient was initially treated with 10 mg of olanzapine, which she tolerated well, and the dose was increased to 20 mg. During her admission, her perceptual disturbance was reduced. However, residual persecutory ideas remained at the time of her discharge, so we changed medication from olanzapine to amisulpride. After 3 months, we increased her amisulpride dose to 400 mg, and her residual symptoms almost disappeared.