Diagnosis and treatment of psychotic symptoms in elderly patients

The diagnosis and treatment of psychotic symptoms in elderly patients requires more than extrapolation from studies of similar symptoms in the adult population. In comparison with early-onset psychosis, late-onset psychosis is characterised by differences in both its risk factors and typical signs and symptoms. Diagnosis may include psychotic disorders, mood disorders, delusional disorder, dementia or delirium. Several medications have also been associated with the development of psychotic symptoms in the elderly. There is a paucity of literature concerning psychotic symptoms specifically in elderly patients, and this complicates management. Treatment involves the resolution of any causative general medical condition, and/or symptomatic management with antipsychotic medication. The high-potency antipsychotics are typically better tolerated in the elderly than their low-potency counterparts. In addition, the newer atypical antipsychotics such as clozapine have shown early promise. It is important to consider the higher incidence of adverse effects and tardive dyskinesia in the elderly when choosing a drug and its dosage. Consideration of psychosocial factors completes the appropriate management of psychotic symptoms in older patients.