Psychosis in the Elderly Handout Package
PSYCHOSIS IN THE ELDERLY What is Psychosis? Impaired cognitive functioning, disorganized thinking and speech Presence of delusions or prominent hallucinations in the absence of insight In the elderly, underlying psychosis may present as a behavioural disturbance Symptoms of Psychosis Cognitive or behavioural disturbances, often manifested as hallucinations or delusions Agitation or aggression are also associated with psychosis in the elderly 1
Hallucination A sensory perception without external basis Types include: Auditory Visual Tactile Somatic Gustatory Olfactory Delusion A fixed, false belief The belief is not one ordinarily accepted by other members of the person s culture Neurodegenerative Disorders Alzheimer Disease Lewy Body Dementia Parkinson s Disease Mood Disorders Depression Mania 2
Delirium Schizophrenia Personality Disorders Medications Alzheimer Disease: Among clients with dementia, Alzheimer disease is the most common Most common feature of dementia is memory loss Memory loss often leads to confusion Vascular Dementia: Can range from multiple strokes to single strategic strokes Cognitive abnormalities vary depending on areas affected 3
Lewy Body Dementia: Fluctuating confusion Prone to hallucinations and delusions Parkinsonism Poor executive functioning, visuo-spatial skills REM sleep disorder Atonia (decreased muscle tone) Dementia in Parkinson s s Disease: Dementia is common in Parkinson s Disease (occurs in 30-40%) Psychosis appears to be associated with depression and older age of onset of Parkinson s Disease Common behavioural symptoms are hallucinations, delusions and apathy Dementia in Parkinson s s Disease: Hallucinations are well-formed, frightening and frequent They are often related to dopaminergic agents 4
Mood Disorders: Depression Mania Delirium: Medical emergency, reversible First sign may be a sudden change in behaviour, or a functional or physical change Conditions that could cause delirium Bugs n Drugs Schizophrenia: Mental illness that presents in early life and usually persists through life (chronic) Late onset is less common, but does occur (paraphrenia) Onset earlier in men than women May display delusions, hallucinations and misinterpretations of reality 5
Schizophrenia Major Symptoms: Thought disturbances Disturbances in perception Disturbances in behaviour Paranoia: A symptom, not a disorder Paranoia and psychosis have many causes May be due to delirium, secondary to a general medical problem Can be associated with depression, dementia and/or other neurological dysfunction Personality Disorders: Rarely develop in the elderly In extreme situations, psychotic symptoms may be exhibited 6
Medications: Use of multiple medications Drug interactions/dosages Withdrawal of medications Overuse of medications Assessment for Psychosis History of present illness History of past psychiatric illness Family history History of medical illness Drug and alcohol use Assessment for Psychosis Cognitive Screen: MMSE Risk Assessment: Violence/suicide Physical Exam Laboratory Tests/Investigations Collateral Information: Partners in Care 7
Interventions for Psychosis Eliminate reversible causes Attend to visual and hearing deficits Medication review Remove external stressors Behavioural interventions Summary Psychosis is the presence of delusions or prominent hallucinations in the absence of insight Psychosis may present as a behavioural disturbance in the elderly 8
Psychosis in the Elderly Resource Package
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