Psychosis in Older Adults

Abstract

There is an increase of the prevalence of psychotic symptoms in older adults. The presence at this period of life of the highest comorbidity rate, the changes of the central nervous system with ageing, and the particular high frequency of life stressors during this period of life may all explain this. Psychotic symptoms are present in an important number of medical and psychiatric conditions and they make part of psychotic disorders in late life too. The same classification of disorders with psychotic symptoms in adults may be used for older adults. Primary psychotic symptoms exist in persistent psychotic disorders (schizophrenia, delusional disorder, and schizoaffective disorder), acute psychotic disorder, and personality disorders (paranoid, schizoid, and schizotypal personality disorders). Secondary psychotic symptoms include major and minor neurocognitive disorders, delirium, organic mental disorders, disorders due to psychoactive substance use, bipolar disorders, and depressive episode. Somatic disorders, comorbidities and iatrogenic causes are included at this cluster. Assessment and management of psychosis in older adults at primary care require an organization of the mental health-care system. The management of psychosis in older adults implies the proper use of multidisciplinary therapeutic interventions: pharmacotherapy and psychological, social, and occupational therapy. All forms of stigma and discrimination against older adults with psychosis and their carers should be eliminated.