3.5.5 Late Life Psychosis

Late Life Psychosis

Late-life psychosis is a common mental health condition that affects the elderly population. In this lesson, we will discuss the prevalence and incidence, clinical features, differential diagnosis, aetiology, management, and prognosis, of late-life psychosis.

Late life psychosis is defined as the presence of delusions, hallucinations, or both, in individuals over the age of 65. The most common type of late life psychosis is delusional disorder, followed by schizophrenia and mood disorders with psychotic features. The prevalence of late life psychosis is estimated to be around 1% in the general population, increasing to up to 10% in those with dementia (1).

Clinical Features: The clinical features of late life psychosis are similar to those seen in younger individuals, with the presence of delusions and hallucinations being the hallmark symptoms. However, there may be differences in the type and content of delusions, with more somatic and paranoid delusions being reported in the elderly population. Additionally, there may be more sensory and perceptual changes associated with hallucinations, such as visual hallucinations of animals or insects (2).

Differential Diagnosis:

Late life psychosis can be difficult to differentiate from other medical conditions such as dementia, delirium, or other psychiatric disorders such as depression or anxiety. It is important to conduct a thorough medical and psychiatric evaluation to rule out other causes of psychosis (2).

Aetiology:

The aetiology of late life psychosis is not well understood, but it is thought to be multifactorial, including genetic, neurobiological, and environmental factors. The presence of comorbid medical conditions, such as Parkinson’s disease or stroke, may also contribute to the development of late life psychosis (3).

Management:

The management of late life psychosis involves a combination of medication and psychosocial interventions. Antipsychotic medications are often prescribed, but there is a higher risk of adverse effects in the elderly population, such as extrapyramidal symptoms or cognitive decline. Therefore, careful monitoring and dose adjustments are necessary. Psychosocial interventions such as supportive therapy and cognitive-behavioural therapy (CBT) may also be helpful in managing symptoms and improving quality of life (2).

Prognosis:

The prognosis of late life psychosis is variable, with some individuals experiencing remission of symptoms and others experiencing a chronic course. The presence of comorbid medical conditions and cognitive impairment may impact the prognosis (4).

Disorder	Prevalence/Incidence	Clinical Features	Differential Diagnosis
Late Life Psychosis	1% in the general population, up to 10% in those with dementia	Delusions, hallucinations, somatic and paranoid delusions	Dementia, delirium, other psychiatric disorders

Disorder	Aetiology	Management	Prognosis
Late Life Psychosis	Multifactorial, genetic, neurobiological, environmental, and comorbid medical conditions	Antipsychotic medications, psychosocial interventions	Variable, impacted by comorbid medical conditions and cognitive impairment

Reference:

1. Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry. 2000;157(5):708-714.
2. Tampi RR, Tampi DJ. Late-Life Psychosis. Am Fam Physician. 2019;99(3):154-162.
3. Fiske A, Wetherell JL, Gatz M. Depression in Older Adults. Annu Rev Clin Psychol. 2009;5:363-389.
4. Alexopoulos GS, Kiosses DN, Klimstra S, Kalayam B, Bruce ML. Clinical Presentation of the “Depression-Executive Dysfunction Syndrome” of Late Life. Am J Geriatr Psychiatry. 2002;10(1):98-106.