As our population ages, the incidence and frequency of psychosis is similarly increasing. Since the likelihood of comorbid illnesses and concomitant medications is also high in the elderly patient, psychoses in the elderly must be considered as a spectrum of disorders. A systematic approach that integrates psychiatric and medical care is required to evaluate psychotic features, since psychosis in the elderly can be due to many underlying etiologies of both neurologic and physiologic origin. The most common causes of psychoses in the elderly include delirium, schizophrenia, mood disorders, dementia, medical and neurological conditions, medications, and substance abuse.
As such, elderly patients presenting with psychotic symptoms may require a coordination of medical, social, behavioral, environmental and/or pharmacologic interventions in order to effectively and comprehensively address the complex needs of the older person with psychosis. This presentation will discuss the impact of co-occurring psychotic and medical disorders on the outcomes and costs of care and findings suggesting that older persons with psychotic disorders are at especially high risk to receive inadequate or inappropriate medical and pharmacological treatments, despite a substantial evidence-based treatment literature. Emerging treatment models will be described that seek to improve quality of care by integrating psychiatric and medical care of the elderly patient with psychosis in outpatient and long-term care settings.
References:
Bartels SJ: Quality, costs, and effectiveness of services for older adults with mental disorders: a selective overview of recent advances in geriatric mental health services research. Curr Opin in Psychiatry 2002;15(4): 411-416.
Bartels SJ, Dums AR, Oxman TE, Schneider LS, Areán PA, Alexopoulos GS, Jeste DV. Evidence-based practices in geriatric mental health. Psychiatr Serv 2002; 53(11):1419-1431.
Bartels SJ, Horn SD, Smout RJ, Dums AR. Agitation and depression in frail nursing home elderly with dementia: Treatment characteristics and service use. Am J of Geriatr Psychiatry 2003;11(2): 231-238.
Targum, S. Treating psychotic symptoms in elderly patients. J Clin Psych (Primary Care Companion) 2001;3:156-163.
Tariot, P. Treatment of agitation in dementia. J Clin Psych 1999;60(suppl 8):11-20. American Psychiatric Association: Practice Guideline for the Treatment of Patients with Delirium. Am J Psych 1999; 156(suppl 5):1-20.
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