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Chapter 15 - Late-Onset Psychosis and Related Disorders

Published online by Cambridge University Press:  04 April 2024

By
Simon Thacker  and
Katie Ward
Edited by
George Tadros  and
George Crowther
George Tadros
Affiliation:
Aston University, Birmingham
George Crowther
Affiliation:
Leeds and York Partnership NHS Foundation Trust, Leeds
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Summary

Late-onset psychosis covers a range of diagnostic possibilities. Both underlying physical and psychiatric disorders may contribute to psychotic experiences. Psychiatrists have expertise in disentangling aetiological factors, assessing risk, and devising appropriate plans of care.

Causes of late-onset psychosis include very late onset schizophrenia-like psychosis (VLSOP), delusional disorder, affective disorder, dementia, and delirium. Early-onset schizophrenia may persist into later life and cause psychotic experiences. Physical factors that might contribute to hallucinations include hearing and visual deficits, medication toxicity, and alcohol.

The clustering of physical and psychosocial stressors in later life makes comprehensive geriatric assessment essential. Psychiatrists often call this holistic assessment ’the biopsychosocial approach’.

The use of the Mental Health Act to sanction involuntary treatment may be required if the risks warrant it.

Medication options for late-onset psychosis are limited by older people’s vulnerability to side effects. Much lower doses of antipsychotic drugs are required than for younger patients. Amisulpride has proven efficacy in VLOSP.

Keywords

late-onset psychosisvery late onset schizophrenia-like psychosis (VLOSP)delusional disorderantipsychotic medicationamisulprideATLAS trial
Type
Chapter
Information
Handbook of Old Age Liaison Psychiatry , pp. 220 - 232
Publisher: Cambridge University Press
Print publication year: 2024

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