The treatment of psychotic disorders in late life

To review the epidemiology, phenomenology, and treatment of psychotic disorders in late life.

The literature relating to psychotic symptoms in the elderly is reviewed, with a focus on the following categories: primary psychotic disorders, mood disorders, delirium, Parkinson's disease (PD), and somatic hallucinoses (including Charles Bonnet syndrome [CBS] and musical hallucinosis). Practical clinical treatment implications are discussed.

The prevalence of psychotic symptoms increases with age, largely because of underlying medical illnesses such as dementia, delirium, and other neurological disorders that are exacerbated by sensory deficits coupled with social isolation. Treatment with the traditional high-potency neuroleptics is complicated by extrapyramidal symptoms, and sedation, postural hypotension, and anticholinergic effects complicate the use of low-potency traditional agents. Although clozapine may have a narrow use in the treatment-resistant schizophrenia and PD, it is poorly tolerated in the elderly. Risperidone has a wider use in this population and has a favourable clinical profile (at low doses). Other new neuroleptics await more formal evaluation in the elderly.

Psychotic disorders in old age have more organic associations, which cause greater difficulty in their treatment. Further Evaluation of the use of atypical agents in this elderly group is indicated.