Psychotic disorders in late life: a narrative review

Abstract

Psychotic disorders are not uncommon in late life. These disorders often have varied etiologies, different clinical presentations, and are associated with significant morbidity and mortality among the older adult population. Psychotic disorders in late life develop due to the complex interaction between various biological, psychological, social, and environmental factors. Given the significant morbidity and mortality associated with psychotic disorders in late life, a comprehensive work-up should be conducted when they are encountered. The assessment should not only identify the potential etiologies for the psychotic disorders, but also recognize factors that predicts possible outcomes for these disorders. Treatment approaches for psychotic disorders in late life should include a combination of nonpharmacological management strategies with the judicious use of psychotropic medications. When antipsychotic medications are necessary, they should be used cautiously with the goal of optimizing outcomes with regular monitoring of their efficacy and adverse effects.

First‐onset psychosis in older adults: social isolation influence during COVID pandemic – a UK case series

“…There is evidence that psychosocial stressors can increase the risk of psychosis in adults above 60 years of age 9 . Typically, the majority of psychotic episodes in this age group are due to a medical illness, illicit drugs or medication effects 17 . None of the cases outlined in this series presented with these symptoms, nor had symptoms consistent with a ‘very late onset of schizophrenia‐like psychosis’ that typically emerges in female adults above 60 years old.…”

“…None of the cases outlined in this series presented with these symptoms, nor had symptoms consistent with a ‘very late onset of schizophrenia‐like psychosis’ that typically emerges in female adults above 60 years old. These patients typically present with cognitive impairments ( ie learning and retention), structural brain abnormalities, and risk of tardive dyskinesia as a side‐effect of treatment 13,14,17 . There were also no signs of a persistent delusional disorder, as the psychosis was an acute presentation, there was no marked blunting of their affect or evidence of brain disease.…”

Clinical Approaches to Late-Onset Psychosis

“…The dosage of medications for treating symptoms was significantly higher for early-onset schizophrenia but lower for late-onset and very late-onset groups [ 23 ]. The risk of tardive dyskinesia was found to be predominantly high for patients with very late-onset schizophrenia [ 6 ].…”

“…The clinical considerations of secondary psychosis in older adults are important for its preponderance, leading to 60% of the etiologies of late-onset psychosis. It is necessary to consider differential diagnoses, including neurodegenerative disorders, characterized by delirium and substance-induced psychosis, and the effects of prescribed medications and illicit drugs [ 5 , 6 ].…”

Psicose induzida por drogas recreativas: uma revisão de literatura

“…Dentre os Transtornos Psicóticos Primários, destaca-se a Esquizofrenia (Tampi, Young, Hoq, Resnik, & Tampi, 2019). As desordens psicóticas secundárias incluem a psicose como sintoma de outros distúrbios, incluindo desordens neurocognitivas, delírio, uso de substâncias ilícitas, ou outros medicamentos e desordens neurológicas (Tampi et al, 2019).…”