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Chapter 15 - Late-Onset Psychosis and Related Disorders

Published online by Cambridge University Press:  04 April 2024

By
Simon Thacker  and
Katie Ward
Edited by
George Tadros  and
George Crowther
George Tadros
Affiliation:
Aston University, Birmingham
George Crowther
Affiliation:
Leeds and York Partnership NHS Foundation Trust, Leeds
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Summary

Late-onset psychosis covers a range of diagnostic possibilities. Both underlying physical and psychiatric disorders may contribute to psychotic experiences. Psychiatrists have expertise in disentangling aetiological factors, assessing risk, and devising appropriate plans of care.

Causes of late-onset psychosis include very late onset schizophrenia-like psychosis (VLSOP), delusional disorder, affective disorder, dementia, and delirium. Early-onset schizophrenia may persist into later life and cause psychotic experiences. Physical factors that might contribute to hallucinations include hearing and visual deficits, medication toxicity, and alcohol.

The clustering of physical and psychosocial stressors in later life makes comprehensive geriatric assessment essential. Psychiatrists often call this holistic assessment ’the biopsychosocial approach’.

The use of the Mental Health Act to sanction involuntary treatment may be required if the risks warrant it.

Medication options for late-onset psychosis are limited by older people’s vulnerability to side effects. Much lower doses of antipsychotic drugs are required than for younger patients. Amisulpride has proven efficacy in VLOSP.

Keywords

late-onset psychosisvery late onset schizophrenia-like psychosis (VLOSP)delusional disorderantipsychotic medicationamisulprideATLAS trial
Type
Chapter
Information
Handbook of Old Age Liaison Psychiatry , pp. 220 - 232
Publisher: Cambridge University Press
Print publication year: 2024

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References

Howard, R., Rabins, P.V., Seeman, M.V., Jeste, D.V., and the International Late-Onset Schizophrenia Group. Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: An international consensus. Am J Psychiatry 2000, 157(2): 172–8.CrossRefGoogle ScholarPubMed
Badcock, J.C., Dehon, H., and Laroi, F. Hallucinations in healthy older adults: An overview of the literature and perspectives for future research. Front Psychol 2017, 8: 1134.CrossRefGoogle ScholarPubMed
Soulas, T., Cleret de Langavant, L., Monod, V., and Fenelon, G. The prevalence and characteristics of hallucinations, delusions and minor phenomena in a non-demented population sample aged 60 years and over. Int J Geriatr Psychiatry 2016, 31(12): 1322–8.CrossRefGoogle Scholar
Teunisse, R.J., Zitman, F.G., Cruysberg, J.R.M., Hoefnagels, W.H.L., and Verbeek, A.L.M. Visual hallucinations in psychologically normal people: Charles Bonnet’s syndrome. Lancet 1996, 347(9004): 794–7.CrossRefGoogle ScholarPubMed
Jacob, A., Prasad, S., Boggild, M., and Chandratre, S. Charles Bonnet syndrome: Elderly people and visual hallucinations. Br Med J 2004, 328(7455): 1552–4.CrossRefGoogle ScholarPubMed
Fornaro, M., and Martino, M. Tinnitus psychopharmacology: A comprehensive review of its pathomechanisms and management. Neuropsychiatr Dis Treat 2010, 6: 209–18.Google ScholarPubMed
Cole, M.G., Dowson, L., Dendukuri, N., and Belzile, E. The prevalence and phenomenology of auditory hallucinations among elderly subjects attending an audiology clinic. Int J Geriatr Psychiatry 2002, 17(5): 444–52.CrossRefGoogle ScholarPubMed
Pinto, P.C.L., Marcelos, C.M., Mezzasalma, M.A., Osterne, F.J.V, de Melo Tavares de Lima, M.A., and Nardi, A.E. Tinnitus and its association with psychiatric disorders: Systematic review. J Larynogol Otol 2014, 128(8): 660–4.Google ScholarPubMed
David, A., Fleminger, S., and Kopelman, M. Lishman’s Organic Psychiatry: A Textbook of Neuropsychiatry, 4th ed. Oxford: Wiley Blackwell, 2009.CrossRefGoogle Scholar
Louhija, U.M., Saarela, T., Juva, K., and Appelberg, B. Brain atrophy is a frequent finding in elderly patients with first episode psychosis. Int Psychogeriatr 2017, 29(11): 1925–9.CrossRefGoogle ScholarPubMed
Thacker, S., Skelton, M., and Harwood, R. Psychiatry and the geriatric syndromes creating constructive interfaces. BJPsych Bull 2017, 41(2): 71–5.CrossRefGoogle ScholarPubMed
Reinhardt, M.M., and Cohen, C.I. Late-life psychosis: Diagnosis and treatment. Curr Psychiatry Rep 2015, 17(2): 1–13.CrossRefGoogle ScholarPubMed
Whittamore, K.H., Goldberg, S.E., Gladman, J.R.F, Bradshaw, L.E., Jones, R.G., and Harwood, R.H. The diagnosis, prevalence and outcome of delirium in a cohort of older people with mental health problems on general hospital wards. Int J Geriatr Psychiatry 2014, 29(1): 32–40.CrossRefGoogle Scholar
Stern, Y., Albert, S., Tang, M.X., and Tsai, W.Y. Rate of memory decline in AD is related to education and occupation. Neurology 1999, 53(9): 1942.CrossRefGoogle ScholarPubMed
Ropacki, S.A., and Jeste, D.V. Epidemiology of and risk factors for psychosis of Alzheimer disease: A review of 55 studies published from 1990 to 2003. Am J Psychiatry 2005, 162(11): 2022–30.CrossRefGoogle ScholarPubMed
Lake, C.R. Hypothesis: Grandiosity and guilt cause paranoia: Paranoid schizophrenia is a psychotic mood disorder: A review. Schizophrenia Bulletin 2008, 34(6): 1151–62.CrossRefGoogle ScholarPubMed
Rao, T., and Crome, I. Our Invisible Addicts. London: Royal College of Psychiatrists, 2018.Google Scholar
Moore, T.H., Zammit, S., Lingford-Hughes, A., Barnes, T.R., Jones, P.B., Burke, M., et al. Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. Lancet 2007, 370(9584): 319–28.CrossRefGoogle ScholarPubMed
Zahodne, L.B., and Fernandez, H.H. Pathophysiology and treatment of psychosis in Parkinson’s disease: A review. Drugs Aging 2008, 25(8): 665–82.CrossRefGoogle ScholarPubMed
Chen, Z., Lusicic, A., O’Brien, T.J., Velakoulis, D., Adams, S.J., and Kwan, P. Psychotic disorders induced by antiepileptic drugs in people with epilepsy. Brain 2016, 139(10): 2668–78.CrossRefGoogle ScholarPubMed
Robinson, D.E., Harrison-Hansley, E., and Spencer, R.F. Steroid psychosis after an intra-articular injection. Ann Rheum Dis 2000, 59(11): 926.CrossRefGoogle ScholarPubMed
Atigari, O.V, and Healy, D. Schizophrenia-like disorder associated with etanercept treatment. Br Med J Case Reports 2014, 13 January: bcr2013200464.CrossRefGoogle Scholar
Wadd, S., Randall, J., and Thake, A.. Alcohol Misuse and Cognitive Impairment. Alcohol Research UK, 2013. https://s3.eu-west-2.amazonaws.com/files.alcoholchange.org.uk/documents/FinalReport_0110.pdf.Google Scholar
Robins, L.N., and Regier, D. Psychiatric Disorders in America. New York: Free Press, 1991.Google Scholar
Meesters, P.D., de Haan, L., Comijs, H.C., Stek, M.L., Smeets-Janssen, M.M.J., Weeda, M.R., et al. Schizophrenia spectrum disorders in later life: Prevalence and distribution of age at onset and sex in a Dutch catchment area. Am J Ger Psychiatry 2012, 20(1): 18–28.CrossRefGoogle Scholar
Kay, D.W.K., and Roth, M. Environmental and hereditary factors in the schizophrenias of old age and their bearing on the general problem of causation in schizophrenia. J Ment Sci 1961, 107: 649–86.CrossRefGoogle ScholarPubMed
Cohen, C.I. Very late-onset schizophrenia-like psychosis: Positive findings but questions remain unanswered. Lancet Psychiatry 2018, 5(7): 528–9.CrossRefGoogle ScholarPubMed
Almeida, O.P., Howard, R.J., Levy, R., and David, A.S. Psychotic states arising in late life (late paraphrenia): Psychopathology and nosology. Br J Psychiatry 1995, 166: 205–14.Google ScholarPubMed
Howard, R., Castle, D., O’Brien, J., Almeida, O., and Levy, R. Permeable walls, floors, ceilings and doors: Partition delusions in late paraphrenia. Int J Geriatr Psychiatry 1992, 7(10): 719–24.CrossRefGoogle Scholar
Lam, C.C.S.F., Reeves, S.J., Stewart, R., and Howard, R. Service and treatment engagement of people with very late-onset schizophrenia-like psychosis. BJPsych Bull 2016, 40(4): 185–6.CrossRefGoogle Scholar
Prager, S., and Jeste, D.V. Sensory impairment in late-life schizophrenia. Schizophrenia Bull 1993, 19(4): 755–72.CrossRefGoogle ScholarPubMed
Brunelle, S., Cole, M.G., and Elie, M. Risk factors for the late-onset psychoses: A systematic review of cohort studies. Int J Geriatr Psychiatry 2012, 27(3): 240–52.CrossRefGoogle ScholarPubMed
Stafford, J., Howard, R., Dalman, C., and Kirkbride, J.B. The incidence of nonaffective, nonorganic psychotic disorders in older people: A population-based cohort study of 3 million people in Sweden. Schizophrenia Bull 2018, suppl_1: S377–378.Google Scholar
Mitter, P., Reeves, S., Romero-Rubiales, F., Bell, P., Stewart, R., and Howard, R. Migrant status, age, gender and social isolation in very late-onset schizophrenia-like psychosis. Int J Geriatr Psychiatry 2005, 20(11): 1046–51.CrossRefGoogle ScholarPubMed
Reeves, S.J., Sauer, J., Stewart, R., Granger, A., and Howard, R.J. Increased first-contact rates for very-late-onset schizophrenia-like psychosis in African and Caribbean-born elders. Br J Psychiatry 2001, 179: 172–4.CrossRefGoogle ScholarPubMed
Jongsma, H.E., Turner, C., Kirkbride, J.B., and Jones, P.B. International incidence of psychotic disorders: A systematic review and meta-analysis. Lancet Public Health 2019, 4(5): 229–244.CrossRefGoogle ScholarPubMed
Stafford, J., Howard, R., and Kirkbride, J.B. The incidence of very late-onset psychotic disorders: A systematic review and meta-analysis. Psychol Med 2018, 48(11): 1775–86.CrossRefGoogle ScholarPubMed
Chen, L., Selvendra, A., Stewart, A., Castle, D. Risk factors in early and late onset schizophrenia. Comp Psychiatry 2018, 80: 155–62.CrossRefGoogle ScholarPubMed
Ting, C., Rajji, T.K., Ismail, Z., Tang-Wai, D.F., Apanasiewicz, N., Miranda, D., et al. Differentiating the cognitive profile of schizophrenia from that of Alzheimer disease and depression in late life. PLoS ONE 2010, 5(4): e10151.CrossRefGoogle ScholarPubMed
Van Assche, L., Morrens, M., Luyten, P., Van de Ven, L., and Vandenbulcke, M. The neuropsychology and neurobiology of late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: A critical review. Neuroscience & Biobehavioral Reviews 2017, 83: 604–21.CrossRefGoogle ScholarPubMed
Harrison, G., Hopper, K., Craig, T., Laska, E. Siegel, , et al. Recovery from psychotic illness: A 15- and 25-year international follow up study. British Journal of Psychiatry 2001, 178: 506–17.CrossRefGoogle ScholarPubMed
Fear, C.F. Recent develpoments in the managment of delusional disorder. Adv Psychiatr Treat 2013, 19(3): 212–20.CrossRefGoogle Scholar
Skelton, M., Khokhar, W.A., and Thacker, S.P Treatments for delusional disorder. Cochrane Database of Systematic Reviews 2015, 5.CrossRefGoogle Scholar
Kay, D.W., Cooper, A.F., Garside, R.F., and Roth, M. The differentiation of paranoid from affective psychosis by patient’s premorbid characteristics. Br J Psychiatry 1976, 129(3): 207–15.CrossRefGoogle Scholar
Reulbach, U., Bleich, S., Biermann, T., Pfahlberg, A., and Sperling, W. Late-onset schizophrenia in child survivors of the Holocaust. J Nerv Ment Dis 2007, 195(4): 315–9.CrossRefGoogle ScholarPubMed
Reeves, S., Stewart, R., and Howard, R. Service contact and psychopathology in very-late-onset schizophrenia-like psychosis: The effects of gender and ethnicity. Int J Geriatr Psychiatry 2002, 17(5): 473–9.CrossRefGoogle ScholarPubMed
Thacker, S. The use of Depot neuroleptics in the elderly: A survey. Int J Geriatr Psychiatry 1996, 11(5): 423–7.3.0.CO;2-9>CrossRefGoogle Scholar
Howard, R., Cort, E., Bradley, R., Harper, E., Kelly, L., Bentham, P., et al. Antipsychotic treatment of very late-onset schizophrenia-like psychosis (ATLAS): A randomised, controlled, double-blind trial. Lancet Psychiatry 2018, 5(7): 553–63.CrossRefGoogle Scholar
Alexopoulos, G., Streim, J., Carpenter, D., and Docherty, J. Using antipsychotics on older patients. Journal of Clinical Psychiatry 2004, 65(suppl 2): 5–99, 100–2 (discussion), 103–4 (quiz).Google ScholarPubMed

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