Psychotic symptoms in the elderly--assessment and management

Psychotic symptoms in the elderly arise in mood disorders, schizophrenia, dementia, and delirium.

This article provides a brief overview of the presentation and management of each condition.

Management follows logically from a thorough mental state examination, medical work up and accurate diagnosis. Depression and mania with psychotic symptoms respond best to an antidepressant and mood stabiliser respectively, usually in combination with antipsychotic medication. Severe cases require electroconvulsive therapy. Atypical antipsychotics are now the treatment of choice in late life schizophrenia. Psychotic symptoms are common in dementia but usually fade within 6-12 months. Doses of psychiatric medications should therefore be lowered every 3 months to check that continued treatment is necessary. Most cases of delirium do not require psychiatric medication.