Psychoses in the elderly: a spectrum of disorders

The incidence of psychoses increases with age with a number of factors leading to the increase in vulnerability and expression. They include comorbid physical illnesses, social isolation, sensory deficits, cognitive changes, polypharmacy, and substance abuse. Agitation and aggressiveness are also associated with psychosis in the elderly and frequently are the precipitating reasons for psychiatric consultation. A review of psychoses in the elderly must, therefore, consider psychotic symptoms within the context of the underlying etiologies of the psychotic symptoms. Elderly patients who present with psychotic symptoms require social, behavioral, and environmental interventions that are necessary for their safety and orientation. Given the likelihood of comorbid medical disorders and concomitant medications, the mere presence of delusions or hallucinations is not always an indication for additional medications. However, some patients may need pharmacologic intervention in order to manage the behavioral disturbance that often results from the psychotic symptoms. The atypical antipsychotics with their low propensity to produce extrapyramidal and cognitive side effects have greatly advanced the pharmacotherapy for elderly patients with psychoses.