Brain atrophy is a frequent finding in elderly patients with first episode psychosis

Background: To characterize the yearly incidence, diagnostic distribution, and neuro-radiologic findings in patients aged over 60 years, referred to psychiatric treatment with first episode psychosis (FEP). Methods: A computerized search, including all patients referred to psychiatric treatment during 12 consecutive months with a de novo diagnosis of psychosis was performed in the Helsinki region catchment area with 1.2 million inhabitants. Diagnoses based on hospital records were made by a group of one neurologist and three psychiatrists. MRI- or CT scans performed as a part of routine clinical management were used when available. Results: 107 patients (27 males and 80 females) with FEP were identified and categorized into four diagnostic groups: schizophrenia, delusional disorder, psychotic depression, and psychosis due to another medical condition. No patients with de novo onset mania were found. Psychosis due to another medical condition was the most common diagnosis. A high frequency of signs of cortical brain atrophy was seen in all diagnostic groups, while central atrophy was more frequent in patients with psychosis due to another medical condition than in the other groups. Conclusion: Organic brain changes related to ageing or degenerative illnesses may be an etiologic factor in elderly patients with FEP.