Late‐Life Psychosis

• Published in: Mount Sinai Expert Guides pp. 322 - 329
• Main Authors: Majeske, Matthew F, Nistor, Violeta, Kellner, Charles H
• Format: Book Chapter
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 06.12.2016
• Subjects: cognitive impairment; dementia; dopaminergic neurons; geriatric patients; lewy body disease; major depressive disorder; neurocognitive disorder; non‐schizophrenic late‐life psychosis; pathophysiology; schizophrenia
• ISBN: 1118654285; 9781118654286
• DOI: 10.1002/9781118654231.ch35

The most common diagnoses associated with psychosis in geriatric patients are, in order, major neurocognitive disorder (dementia) and major depressive disorder (MDD). Visual hallucinations may reflect delirium or neurocognitive disorder (NCD) due to Lewy body disease. This chapter focuses only on non‐schizophrenic late‐life psychosis. Psychosis is a gross impairment of reality testing, often manifest by hallucinations or delusions. Psychotic symptoms can be an inherent aspect of an illness or a secondary complicating factor. Earlier‐onset/primary psychotic disorders, schizophrenia and related disorders, bipolar disorder with psychotic features, often extend into old age. Severe functional disability affects the surrounding environment and worsens caregiver stress, leading to reduced productivity beyond that of the patient. The aging brain shows a disproportion in the synthesis, discharge, and inactivation of noradrenergic, serotonergic, and dopaminergic neurons, loss of resilience, and loss of cognitive reserve, all increasing the risk for psychosis developing as a complication of an underlying pathology.