Deena Tampi Co-Authors: Psychotic disorders in late life: a narrative review

Wednesday, October 23, 2019

Rajesh R. Tampi , Juan Young, Rakin Hoq, Kyle Resnick and Deena J. Tampi

Abstract: Psychotic disorders are not uncommon in late life. These disorders often have varied etiologies, different clinical presentations, and are associated with significant morbidity and mortality among the older adult population. Psychotic disorders in late life develop due to the complex interaction between various biological, psychological, social, and environmental factors. Given the significant morbidity and mortality associated with psychotic disorders in late life, a comprehensive work-up should be conducted when they are encountered. The assessment should not only identify the potential etiologies for the psychotic disorders, but also recognize factors that predicts possible outcomes for these disorders. Treatment approaches for psychotic disorders in late life should include a combination of nonpharmacological management strategies with the judicious use of psychotropic medications. When antipsychotic medications are necessary, they should be used cautiously with the goal of optimizing outcomes with regular monitoring of their efficacy and adverse effects.

Keywords: delusional disorder, elderly, geriatric, late life, late-onset schizophrenia, psychotic disorders, schizoaffective disorder, schizophrenia, very late-onset schizophrenia-like psychosis Received: 13 April 2019; revised manuscript accepted: 25 September 2019.

Introduction

Although a formal definition of ‘psychosis’ is not stated in either the DSM-5 or the ICD classification systems, psychotic features include the presence of delusions, hallucinations, disorganized thinking (speech), grossly disorganized motor behavior (including catatonia), or negative symptoms. (1–3)   When disorders are associated with psychotic features, they are termed psychotic disorders, for example, Schizophrenia Spectrum and Other Psychotic Disorders (DSM-5). The etiologies for psychosis in late life differs from psychosis in younger individuals, with a greater incidence of secondary causes for psychosis among older adults.(4) In addition, psychosis in late life is associated with higher rates of morbidity and mortality when compared with psychosis among younger adults.(5) rthermore, the treatment of psychosis is complicated by the higher incidence of adverse effects when antipsychotic medications are prescribed to older adults when compared with younger adults.(6) 

This intends to provide a comprehensive narrative review of the epidemiology, diagnostics, risks factors, and pathophysiology, as well as the treatment of psychotic disorders of late life. This review includes studies obtained through a literature search of the PubMed, MEDLINE, and Cochrane collaboration databases on 20 March 2019 using keywords related to each section about psychotic disorders in elderly patients (e.g. epidemiology of psychosis in late life, treatment of psychotic disorders in late life, psychosis in neurocognitive disorders, affective psychosis in late life, schizophrenia in late life,ICD-11 schizophrenia, etc.). The search was conducted by all authors, and if there were disagreements regarding the inclusion or exclusion of papers, a consensus was reached through discussion amongst all the authors. The authors included studies that they thought would be beneficial in educating practitioners about psychotic disorders in late life. The search was not restricted by the age of the participants.  This review only included studies in human subjects published in English-language journals or those with official English translations. Studies that were included in this manuscript were not estricted by date of publication.

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