Late-life psychosis: making the diagnosis and controlling symptoms

Psychosis is best considered as a state of brain dysfunction characterized by delusions, hallucinations, and formal thought disorder. The greatest risk factor for the development of late-life psychosis is the presence of a progressive dementia. Management of the psychotic patient incorporates nonpharmacologic and pharmacologic interventions. Neuroleptics are the most common treatment for psychosis; they generally have very similar efficacy, and thus the choice of agent generally depends on the side effect profile. The newer atypical neuroleptics have relatively fewer anticholinergic and extrapyramidal effects and therefore are often good choices for the older population.