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Late-Life Psychosis: Diagnosis and Treatment

  • Geriatric Disorders (W McDonald, Section Editor)
  • Published:
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Abstract

Psychosis is one of the most common conditions in later life with a lifetime risk of 23 %. Despite its high prevalence, late-onset psychosis remains a diagnostic and treatment dilemma. There are no reliable pathognomonic signs to distinguish primary or secondary psychosis. Primary psychosis is a diagnosis of exclusion and the clinician must rule out secondary causes. Approximately 60 % of older patients with newly incident psychosis have a secondary psychosis. In this article, we review current, evidence-based diagnostic and treatment approaches for this heterogeneous condition, emphasizing a thorough evaluation for the “six d’s” of late-life psychosis (delirium, disease, drugs dementia, depression, delusions). Treatment is geared towards the specific cause of psychosis and tailored based on comorbid conditions. Frequently, environmental and psychosocial interventions are first-line treatments with the judicious use of pharmacotherapy as needed. There is an enormous gap between the prevalence of psychotic disorders in older adults and the availability of evidence-based treatment. The dramatic growth in the elderly population over the first half of this century creates a compelling need to address this gap.

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Conflict of Interest

Michael M. Reinhardt has received a training grant from the Health Resources and Services Administration.

Carl I. Cohen receives funding from the Health Resources and Services Administration and the State University of New York Health Network of Excellence.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1203, Brooklyn, NY, 11203, USA

    Michael M. Reinhardt & Carl I. Cohen

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  1. Michael M. Reinhardt
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  2. Carl I. Cohen
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Correspondence to Michael M. Reinhardt.

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This article is part of the Topical Collection on Geriatric Disorders

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Reinhardt, M.M., Cohen, C.I. Late-Life Psychosis: Diagnosis and Treatment. Curr Psychiatry Rep 17, 1 (2015). https://doi.org/10.1007/s11920-014-0542-0

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