Kiran Rabheru, MD, CCFP, FRCP(C)
Active Staff, Geriatrics Psychiatry,
London Psychiatric Hospital, London, ON.
Psychotic disorders in older adults, characterized by a loss of touch from reality, are common and challenging to manage in primary care. Symptoms include delusions, hallucinations, thought disorder and bizarre behaviour. As psychiatric wards many of which still house many older patients with psychosis, close across the country, nursing homes are quickly taking over their role as the "psychiatric hospitals of tomorrow." Nursing homes are often not well equipped to care for older patients with psychosis, many of whom also suffer from dementia, depression and other medical conditions. There are virtually no demographics available on older people with psychosis who live on our streets. The social and economic burden of these disorders is high. The spectrum of psychotic disorders in the elderly is broader than that in younger adults, with some important clinical and epidemiological differences.
DSM-IV differentiates between primary psychotic disorders and disorders with secondary delusions. Although the secondary causes of psychosis in older adults are extremely important to consider, the focus of this article will be on the most common causes of primary psychotic disorders.