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Overview of late-onset psychoses
D P Devanand1, Dilip V Jeste2, T Scott Stroup1
1Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA.
International Psychogeriatrics
|March 3, 2023
Summary
Late-onset psychosis, occurring after age 40, has diverse causes requiring careful diagnosis. Older adults need cautious management due to increased medication risks, highlighting the need for safer treatments.
Area of Science:
- Geriatric Psychiatry
- Neuroscience
- Clinical Psychology
Background:
- Late-onset psychosis (first episode after age 40) presents diagnostic and therapeutic challenges.
- It causes significant distress and increased mortality in patients and caregivers.
- Identifying underlying etiologies is crucial for effective management.
Purpose of the Study:
- To review the epidemiology, clinical features, neurobiology, and therapeutics of late-onset psychoses.
- To highlight the differential diagnosis of psychosis in older adults.
- To discuss the challenges in treating psychosis in the elderly population.
Main Methods:
- Comprehensive literature review using PubMed, MEDLINE, and Cochrane Library.
- Inclusion of search terms covering various psychotic disorders and neurological conditions.
- Overview of epidemiology, clinical presentation, neurobiology, and treatment strategies.
Main Results:
- Late-onset schizophrenia, delusional disorder, and psychotic depression exhibit unique characteristics.
- Secondary psychoses necessitate investigation into neurodegenerative, metabolic, infectious, inflammatory, and toxic causes.
- Psychosis in dementia (Alzheimer's, Lewy body, Parkinson's) is common, associated with poor prognosis, and lacks approved treatments.
Conclusions:
- Accurate diagnosis and prognosis estimation are vital due to the varied causes of late-onset psychosis.
- Older adults are more vulnerable to psychotropic medication side effects, requiring cautious management.
- Further research is needed for developing safe and effective treatments for late-onset psychotic disorders.
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