[Confusional and delusional states in the elderly: diagnostic and therapeutic orientations]

Confusional and delusional disorders in the elderly have specificities and can set diagnostic and therapeutic problems. The confused elder is more often anxious, very disoriented, with poor onirism, disturbed sleep, ideas of persecution and behavior disorders. Even if a multiple causality is usual, initiating circumstances come principally from an affective source. There is rupture with customary situation of the elder which hold a plurality of risk factors. These confusional disorders increase with aging and cognitive impairment. Late life delusional subject has also persecutory ideation without dissociation but with emotional reactions and affective changes. Different factors promote birth of late life delusion (personality features, isolation, sensory defect...). On psychodynamic way, these two disorders are issued from a breakdown followed by a more or less durable appointment. Confusion agrees with a somatic and psychic regression (consciousness disorganization). This is an elder's attempt to prevent anxiety. Late life delusion lays on denial and projective mecanisms. It is jointed with prejudice and intrusion (with regard to ownership, health and reputation). This is an elder's attempt to establish defences against depression. In the two situations, treatment consists on a biological regulation associated with psychodynamic approach taking elder personality, actual condition and recent life events into account.