Updates in Geriatric Psychiatry-view handout:slides

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Psychotic symptoms are common among older adults, with prevalence rates varying depending on age and specific disorders. Among 85-year-olds, about 10% experience psychotic symptoms, such as hallucinations, delusions, and paranoid ideation. For 95-year-olds, the prevalence rate drops slightly to 7%. In individuals without dementia, the prevalence of psychotic symptoms is also significant, with affective psychoses occurring at a rate of 30.9 per 100,000 person-years at risk and schizophrenia at a rate of 7.5 per 100,000 person-years at risk.<br /><br />When evaluating new-onset psychosis in late life, a thorough diagnostic workup is crucial. This includes obtaining a comprehensive history from the patient and significant others, assessing psychiatric and medical history, conducting physical and neurological examinations, and performing laboratory tests, neuroimaging, and neuropsychological testing.<br /><br />Treatment for psychotic symptoms in older adults involves a combination of pharmacotherapy and psychosocial interventions. Antipsychotic medications are commonly used, but their use should be carefully monitored due to potential risks, such as sedation, anticholinergic symptoms, and metabolic side effects. Non-pharmacologic treatments, including psychosocial rehabilitation programs, cognitive-behavioral therapy, and family-based services, are recommended.<br /><br />Certain disorders, such as Parkinson's disease, require specific consideration in treatment. In Parkinson's disease, reducing dopaminergic medications and implementing non-pharmacologic strategies, such as cognitive techniques and visual techniques, can help manage psychotic symptoms. Additionally, antipsychotic medications like clozapine, quetiapine, and pimavanserin have been found to be effective in treating psychosis associated with Parkinson's disease.<br /><br />Overall, a comprehensive approach that takes into account the specific disorder, individual's medical history, and potential risks and benefits of treatment options is essential in managing psychotic symptoms in older adults. Continued monitoring and informed consent conversations are also important in optimizing treatment outcomes while minimizing harm.

Keywords

psychotic symptoms

older adults

prevalence rates

hallucinations

delusions

paranoid ideation

diagnostic workup

pharmacotherapy

psychosocial interventions

Parkinson's disease