Psychotic Symptoms and Syndromes

Approximately 15% of older adults report psychotic symptoms, and primary psychotic disorders account for less than half. Onset of psychosis and other psychiatric symptoms after age 40, atypical presentations, or symptoms resistant to treatment may indicate a non-primary psychiatric etiology and should prompt a thorough medical work-up. Neurodegenerative diseases can be associated with psychiatric (commonly anxiety, mood, or psychotic) symptoms, along with cognitive deficits. For this reason, cognitive screening tests should be conducted with all patients presenting with late-onset psychotic symptoms. In this chapter, we will discuss a step-by-step approach to the evaluation and differential diagnosis of psychosis in older adults, review primary psychotic disorders and common neurodegenerative and other neurological diseases that can present with psychosis, and outline pharmacological and non-pharmacological management approaches.