วิจัย

Chronic mental illness in LTCF

Abhilash K. Desai MD
Medical Director
Alzheimer’s Center of Excellence

Chronic mental illness
1. Schizophrenia and Schizoaffective
disorder.
2. Bipolar disorder (Type 1 and Type 2).
Others: Major Depressive Disorder
Recurrent and Post Traumatic Stress
Disorder.
This presentation will focus on the first
two.

Other psychiatric disorders.
Psychiatric disorders in developmentally disabled
residents, generalized anxiety disorder, social
phobias, panic disorder with or without
agoraphobia, somatoform disorders, personality
disorders, drug and alcohol use disorders are also
important cause of morbidity and mortality, more
common than chronic mental illnesses and thus
need to be recognized and treated aggressively.

1

Prevalence in nursing homes
5% for major illnesses but actual prevalence may
be higher. Higher prevalence in government
owned/run facilities.
Long past history of psychiatric treatment.
Typically comorbid with stroke, dementia or
other severe medical illnesses. Occasionally in
long term care facility due to social reasons.
Associated with high resource utilization, high
risk of suicide, hospitalization, non-compliance
and higher doses of psychotropics and other
complications.

Schizophrenia and Bipolar I.
Extreme sensitivity to stress is a common factor.
Even daily hassles may lead to deterioration and
cognitive problems. The impact of stress on
dopamine release may be the underlying
mechanism in these disorders. Hence the potential
benefits of dopamine blocking agents for both
these disorders.
Genetic factors. One parent: 10% risk of
schizophrenia and 25% risk of bipolar disorder.
Both parents: risk doubles. Twins: 50%, 60%.

Schizophrenia and Bipolar I
There is increased risk of schizophrenia among
relatives of patients with bipolar disorder, and
vice versa.
Several genes involved in the development,
stabilization, and function of synapses have been
linked to...