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.

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.

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.