Svante Östling, MD, PhD, Sahlgrenska Academy at Göteborg University, Institute of Clinical Neuroscience and Physiology, Psychiatry Section, Mölndal, Sweden.

The growing proportion of older adults in the population has increased the interest in psychiatric symptoms and disorders that seriously compromise the quality of life in this age group. Psychotic symptoms are common among both demented and nondemented older adults and demand resources from the social and health care systems. There are different etiologies of these symptoms, and different possible underlying medical contributing illnessess, concomitant medications, dementia, delirium, and psychiatric comorbidities should be identified before a specific antipsychotic treatment is considered.
Key words: psychosis, hallucinations, delusions, paranoid older adults.

Muzumel A. Chaudhary, MD, Psychiatry Resident, University of British Columbia, Vancouver, BC.
Kiran Rabheru, MD, CCFP, FRCP, ABPN, Clinical Associate Professor, Department of Psychiatry, University of British Columbia; Geriatric Psychiatrist, Vancouver General, University of British Columbia, and Riverview Hospitals, Vancouver, BC.

New-onset paranoid symptoms are common among older individuals. They can signify an acute mental status change owing to medical illness, correspond to behavioural and psychological symptoms of dementia, or equate to an underlying affective or primary psychotic mental disorder. The implications of paranoid symptoms are considerable and affect patients, families, and caregivers alike. Accurate identification, diagnosis, and treatment of late-life paranoid symptoms present a unique clinical challenge as issues of morbidity and mortality are inherent both to the illness state and available treatment approaches.
Key words: paranoia, delusions, etiology, older adults, atypical antipsychotic.

Abi V. Rayner MD MPH, Buller Medical Service, Westport, New Zealand.

Psychotic symptoms, hallucinations, and delusions, arising de novo in older adults, represent a major risk factor for the development of dementia, illness, delirium, functional impairment and death. These symptoms and associated behavioural manifestations overlap with depressive disorders and may be signs of cognitive impairment or dementia. Symptoms may be vague or legitimized so that the psychosis is unrecognized by family and physicians. Specific queries regarding the nature of the symptoms and the impact on function will provide diagnostic clues. Several brief assessment tools can be used in primary care, specifically the NPI-Q and Blessed Dementia Scale.
Key words: psychosis, hallucinations, delusions, dementia, depression.