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Late Onset Psychosis. Review

Published online by Cambridge University Press:  23 March 2020

J.M. Hernández Sánchez*
Affiliation:
Valencia, SpainValencia, Spain
M.Á. Canseco Navarro
Affiliation:
Hospital General de Valencia, Psychiatry, Valencia, Spain
M. Machado Vera
Affiliation:
Hospital General de Valencia, Psychiatry, Valencia, Spain
C. Garay Bravo
Affiliation:
Hospital General de Valencia, Psychiatry, Valencia, Spain
D. Peña Serrano
Affiliation:
Hospital Generla de Valencia, Psychiatry, Valencia, Spain
*
*Corresponding author.

Abstract

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Introduction

Several risk factors make older adults more prone to psychosis. The persistent growth in the elderly population makes important the necessity of accurate diagnosis of psychosis, since this population has special features especially regarding to the pharmacotherapy and side effects.

Objectives

To review the medical literature related to late-life psychosis.

Methods

Medline search and ulterior review of the related literature.

Results

Reinhard et al. [1] highlight the fact that up to 60% of patients with late onset psychosis have a secondary psychosis, including: metabolic (electrolite abnormalities, vitamines defficiency…); infections (meningitides, encephalitides…); neurological (dementia, epilepsy…); endocrine (hypoglycemia…); and intoxication. Colijn et al. [2] describe the epidemiological and clinical features of the following disorders: schizophrenia (0.3% lifetime prevalence > 65 years); delusional disorder (0.18% lifetime prevalence); psychotic depression (0.35% lifetime prevalence); schizoaffective disorder (0.32% lifetime prevalence); Alzheimer disease (41.1% prevalence of psychotic symptoms); Parkinson's disease (43% prevalence of psychotic symptoms); Parkinson's disease dementia (89% prevalence of visual hallucinations); Lewy body dementia (up to 78% prevalence of hallucinations) and vascular dementia (variable estimates of psychotic symptoms). Recommendations for treatment include risperidone, olanzapine, quetiapine, aripiprazole, clozapine, donepezil and rivastigmine.

Conclusions

Differential diagnosis is tremendously important in elderly people, as late-life psychosis can be a manifestation of organic disturbances. Mental disorders such as schizophrenia or psychotic depression may have different manifestations in comparison with early onset psychosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
EV977
Copyright
Copyright © European Psychiatric Association 2016

References

Reinhard, M.M. Late-life psychosis: diagnosis and treatment. Curr Psychiatry Rep 1722015 1CrossRefGoogle Scholar
Colijn, M.A., et al.Psychosis in later life: a review and update. Harv Rev Psychiatry 2352015 354367CrossRefGoogle ScholarPubMed
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