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Psychosis in the Elderly

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					Psychosis in the Elderly
   Handout Package
     PSYCHOSIS IN
      THE ELDERLY




    What is Psychosis?
n   Impaired cognitive functioning,
    disorganized thinking and speech
n   Presence of delusions or prominent
    hallucinations in the absence of
    insight
n   In the elderly, underlying psychosis
    may present as a behavioural
    disturbance




    Symptoms of Psychosis
n    Cognitive or behavioural
     disturbances, often manifested as
     hallucinations or delusions
n    Agitation or aggression are also
     associated with psychosis in the
     elderly




                                           1
 Hallucination
 n    A sensory perception without
      external basis
 n    Types include:
        •   Auditory
        •   Visual
        •   Tactile
        •   Somatic
        •   Gustatory
        •   Olfactory




  Delusion

                 n   A fixed, false belief…

                 n   The belief is not one
                     ordinarily accepted by
                     other members of the
                     person’s culture




 Causes of Psychosis
Neurodegenerative Disorders
  n   Alzheimer Disease
  n   Lewy Body Dementia
  n   Parkinson’s Disease

Mood Disorders
  n   Depression
  n   Mania




                                              2
    Causes of Psychosis
    n   Delirium
    n   Schizophrenia
    n   Personality Disorders
    n   Medications




    Causes of Psychosis
Alzheimer Disease:
n   Among clients with dementia,
    Alzheimer disease is the most common
n   Most common feature of dementia is
    memory loss

n   Memory loss often leads to confusion




    Causes of Psychosis
Vascular Dementia:
n Can range from multiple strokes to
  single strategic strokes

n   Cognitive abnormalities vary
    depending on areas affected




                                           3
    Causes of Psychosis
Lewy Body Dementia:
n    Fluctuating confusion
n    Prone to hallucinations and delusions
n    Parkinsonism
n    Poor executive functioning, visuo-spatial
     skills
n    REM sleep disorder
n    Atonia (decreased muscle tone)




    Causes of Psychosis
            Parkinson’
Dementia in Parkinson’s Disease:
n   Dementia is common in Parkinson’s Disease
    (occurs in 30-40%)

n   Psychosis appears to be associated with
    depression and older age of onset of
    Parkinson’s Disease

n   Common behavioural symptoms are
    hallucinations, delusions and apathy




    Causes of Psychosis
            Parkinson’
Dementia in Parkinson’s Disease:
n    Hallucinations are well-formed, frightening
     and frequent

n    They are often related to dopaminergic
     agents




                                                   4
 Causes of Psychosis

    Mood Disorders:
    n   Depression

    n   Mania




 Causes of Psychosis
Delirium:
n Medical emergency, reversible

n First sign may be a sudden change in

  behaviour, or a functional or physical
  change
n Conditions that could cause delirium –

  “Bugs ‘n Drugs”




 Causes of Psychosis
Schizophrenia:
n Mental illness that presents in early life
  and usually persists through life
  (chronic)
n Late onset is less common, but does
  occur (paraphrenia)
n Onset earlier in men than women

n May display delusions, hallucinations
  and misinterpretations of reality




                                               5
    Causes of Psychosis
Schizophrenia
Major Symptoms:
    n   Thought disturbances
    n   Disturbances in perception
    n   Disturbances in behaviour




    Causes of Psychosis
Paranoia:
n A symptom, not a disorder

n Paranoia and psychosis have many causes

n May be due to delirium, secondary to a

  general medical problem
n Can be associated with depression,

  dementia and/or other neurological
  dysfunction




    Causes of Psychosis
Personality Disorders:
n   Rarely develop in the elderly
n   In extreme situations, psychotic
    symptoms may be exhibited




                                            6
    Causes of Psychosis
Medications:
n    Use of multiple medications
n    Drug interactions/dosages
n    Withdrawal of medications
n    Overuse of medications




    Assessment for Psychosis
n   History of present illness
n   History of past psychiatric illness
n   Family history
n   History of medical illness
n   Drug and alcohol use




    Assessment for Psychosis
n   Cognitive Screen: MMSE
n   Risk Assessment: Violence/suicide
n   Physical Exam
n   Laboratory Tests/Investigations
n   Collateral Information: Partners in
    Care




                                          7
    Interventions for Psychosis
n   Eliminate reversible causes
n   Attend to visual and hearing
    deficits
n   Medication review
n   Remove external stressors
n   Behavioural interventions




    Summary
n   Psychosis is the presence of
    delusions or prominent
    hallucinations in the absence of
    insight
n   Psychosis may present as a
    behavioural disturbance in the
    elderly




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