Objective: To review the most frequent causes of psychotic symptoms in later life, as well as the best available strategies for the management of older adults with psychotic disorders treated in non-psychiatric medical settings.
Design: Cross-sectional study.
Materials and Methods: Non-systematic review of the literature and description of the results of a cross-sectional investigation of 150 older adults sequentially referred to a specialised consultation-liaison (CL) service of psychiatry of old age.
Results: Psychotic symptoms were present in 22% of subjects referred to the service. The most frequent diagnosis associated with psychotic symptoms were dementia, followed by delirium, depression and persistent delusional disorder. In 15% of cases, the referring clinician had not identified the presence of psychosis at the time of referral. The management of subjects included expert advice to the treating team, change of medication, introduction of an antipsychotic agent or use of cholinesterase inhibitors.
Conclusion: Psychotic symptoms are frequent amongst older adults referred to CL services. The management plan for patients with psychotic symptoms should take into account the environment in which the patient is in, expectations/knowledge of the patient and the treating team, and the clinical diagnosis.
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