psychotic disorders Psychosis in late life may be a primary psychotic disorder such as schizophrenia or, more often, a secondary one such as psychosis of Alzheimer disease. Contrary to expectation, aging of patients with schizophrenia is often associated with improvement in mental health-related quality of life even as physical health declines. At the same time, approximately 20% of patients manifest symptoms of schizophrenia for the first time after age 40. We have found several meaningful differences between late- versus early-onset schizophrenia, which remain significant after controlling for other demographic and clinical variables. These results support the notion that late-onset schizophrenia may be a distinct subtype of schizophrenia. Psychosis occurs in 50% of ad patients, and is associated with increased risk of institutionalization.
management Antipsychotics are a commonly used pharmacologic option for the treatment of various psychotic disorders, although these medications have been approved in the US by the Food and Drug Administration (fda) only for schizophrenia and bipolar disorder. An advantage for atypical antipsychotics in terms of lower risk of extra-pyramidal symptoms and tardive dyskinesia has been noted compared to conventional neuroleptics. However, the fda's black-box warnings about strokes and mortality with atypical antipsychotics in elderly patients with dementia have led to considerable confusion with respect to optimal treatment of these patients. A careful consideration of risk:benefit ratio of atypical antipsychotics as well as that of available alternative treatments is needed in each patient. Psychosocial treatments have an important role to play in older psychotic patients. Among middle-aged and elderly people with schizophrenia, randomized controlled trials by our group have demonstrated that psychosocial interventions are efficacious, practical, and acceptable to older patients with schizophrenia being treated with medications. Shared decision making involving patients and caregivers is necessary for choosing specific treatments for specific patients.