Psychosis in the Elderly
Psychosis in the elderly represents a frequent and challenging feature, with a prevalence of psychotic symptoms that may reach 10–63% in the hospitalized population. However, both the diagnosis and the treatment of psychotic symptoms in the elder population may present many problems.
In the present chapter, we debate the differential diagnosis between the causes of psychosis in the elderly and how to deal with them. The first cause of psychosis in this population is represented by dementia. Psychiatric symptoms may be present not only in the last phases of neurodegenerative disorders but also in the early stages or at onset, more frequently in specific subtypes of dementia, such as frontotemporal dementia. The second most common cause of psychosis in the geriatric population is depression, while delirium is the third. Delirium, differently from the other described diagnoses, is characterized by an acute change in mental status, disturbances of consciousness, and clouded sensorium and may be caused by several circumstances, ranging from infections to inappropriate medication use.
Considering the background of the present literature, we report the case of a 66-year-old man who was referred to our inpatient clinic for a manic episode with delusions. We investigated the differential diagnostic processes, which encompass a comprehensive clinical evaluation, a very accurate anamnestic interview, blood tests, and eventually brain imaging. Another major issue of concern is treatment, which might be guided by a multidisciplinary endeavor, including pharmacological and non-pharmacological interventions.
KeywordsElderly Psychosis Bipolar disorder
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