Late-onset psychose: een diagnostische en therapeutische uitdaging voor de clinicus

Abstract

Late-onset psychosis: a diagnostic and therapeutic challenge for the clinician In clinical practice, doctors are frequently confronted with psychosis in the elderly (above 60 years). This symptomatology presents a diagnostic and therapeutic challenge for the clinician. Its cause may be primarily psychiatric or secondary to a somatic or neurological disorder. In this article, the case of an elderly woman presenting with typical partition delusions (the belief that something or someone exerts influence through impermeable structures) is described. This case illustrates the difficult differential diagnosis between primary psychiatric disorders and neurocognitive disorders with late-onset psychotic symptoms, as well as the discussion concerning the nosological classification of schizophrenia in the elderly population. At the end of the 20th century, the term ‘very late-onset schizophrenia-like psychosis’ was introduced for schizophrenia-like psychotic symptoms developing after the age of 60. To this day, the validity of the existence and the etiology of this subgroup of schizophrenia remain a matter of debate. Psychosocial interventions are the first step in the treatment of late-onset psychotic symptoms. The use of antipsychotics is reserved for persistent, severe and debilitating symptoms because of the many side effects in the elderly population. However, the symptoms are often intrusive and have a negative impact on general functioning, so that drug treatment is regularly used in clinical practice.