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date: 27 February 2021

Abstract and Keywords

Psychosis is common among older adults and represents a risk factor for institutionalization and other negative outcomes. There is a broad array of causes of psychosis in older people, which often makes differential diagnosis challenging. We provide a general approach to the assessment of psychosis in older people, focusing on disentangling psychiatric illnesses from emergent medical and toxic causes of psychosis. We then focus on the prevalence, course, assessment, and management of psychotic disorders in older age, concentrating on schizophrenia and bipolar disorder. Although these illnesses are less common among younger adults, psychotic disorders in later life are associated with substantial disability and high utilization of chronic and acute care services, particularly when cognitive impairments are present. We then provide an overview of the phenomenological differences between psychotic disorders and psychotic symptoms in dementia, such as in Alzheimer’s disease. Dementia is the leading cause of psychotic symptoms in older adults, and can be particularly distressing to care-givers. Throughout, we discuss the current controversies and guidance on the management of psychosis in older adults, focusing on the mitigation of adverse effects of pharmacologic agents and psychosocial treatment approaches.

Keywords: psychosis, schizophrenia, bipolar disorder, dementia, Alzheimer's disease, psychopharmacology, psychosocial interventions

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