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Overview of late-onset psychoses

Published online by Cambridge University Press:  03 March 2023

D.P. Devanand Open the ORCID record for D.P. Devanand [Opens in a new window] ,
Dilip V. Jeste ,
T. Scott Stroup  and
Terry E. Goldberg Open the ORCID record for Terry E. Goldberg [Opens in a new window]
D.P. Devanand*
Affiliation:
Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
Dilip V. Jeste
Affiliation:
Departments of Psychiatry, Neurosciences University of California San Diego, La Jolla, USA
T. Scott Stroup
Affiliation:
Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
Terry E. Goldberg
Affiliation:
Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
*
Correspondence should be addressed to: D.P. Devanand, MD, 1051 Riverside Drive, Unit 126, New York, NY, USA. Email: dpd3@cumc.columbia.edu
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Abstract

Background:

Several etiologies can underlie the development of late-onset psychosis, defined by first psychotic episode after age 40 years. Late-onset psychosis is distressing to patients and caregivers, often difficult to diagnose and treat effectively, and associated with increased morbidity and mortality.

Methods:

The literature was reviewed with searches in Pubmed, MEDLINE, and the Cochrane library. Search terms included “psychosis,” “delusions,” hallucinations,” “late onset,” “secondary psychoses,” “schizophrenia,” bipolar disorder,” “psychotic depression,” “delirium,” “dementia,” “Alzheimer’s,” “Lewy body,” “Parkinson’s, “vascular dementia,” and “frontotemporal dementia.” This overview covers the epidemiology, clinical features, neurobiology, and therapeutics of late-onset psychoses.

Results:

Late-onset schizophrenia, delusional disorder, and psychotic depression have unique clinical characteristics. The presentation of late-onset psychosis requires investigation for underlying etiologies of “secondary” psychosis, which include neurodegenerative, metabolic, infectious, inflammatory, nutritional, endocrine, and medication toxicity. In delirium, psychosis is common but controlled evidence is lacking to support psychotropic medication use. Delusions and hallucinations are common in Alzheimer’s disease, and hallucinations are common in Parkinson’s disease and Lewy body dementia. Psychosis in dementia is associated with increased agitation and a poor prognosis. Although commonly used, no medications are currently approved for treating psychosis in dementia patients in the USA and nonpharmacological interventions need consideration.

Conclusion:

The plethora of possible causes of late-onset psychosis requires accurate diagnosis, estimation of prognosis, and cautious clinical management because older adults have greater susceptibility to the adverse effects of psychotropic medications, particularly antipsychotics. Research is warranted on developing and testing efficacious and safe treatments for late-onset psychotic disorders.

Keywords

older adultsecondary psychosisschizophreniadelusional disorderdementiadelirium
Type
Review Article
Information
International Psychogeriatrics , Volume 36 , Special Issue 1: Issue Theme: Schizophrenia and Other Psychotic Disorders in Later Life , January 2024 , pp. 28 - 42
Copyright
© International Psychogeriatric Association 2023

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