Elderly psychotic syndromes are conditions in which a senior develop psychotic symptoms, such as delusions or hallucinations. Their cause may be mental disorders, mental diseases (e.g. schizophrenia or mood disorders) or exacerbation of an existing chronic somatic disease (e.g. heart failure or diabetes). In the treatment of psychotic syndromes in old age, the same drugs are used as for psychosis in younger patients, but there are some differences - what?
Elderly psychotic syndromesare often neglected, and can be - both for the caregivers and the patient - an incredible burden and difficulty in everyday life.
The percentage of elderly people in the human population is systematically growing - the increase in human life expectancy is caused, for example, by the continuous advances in the field of medical science and the resulting more and more effective methods of treating many different diseases.
Different populations in the world are aging, it is no different in Poland. As in 2010, the percentage of people over 65 in our country was 13.5%, it is estimated that in 2035 it will exceed 23%, and in 2060 even 36%.
The growing share of seniors in the entire population means that more and more attention is focused on he alth problems encountered in this age group. Typically, attention is paid to various somatic diseases, such as heart failure, diabetes or ischemic heart disease. There is also a lot of talk about seniors' problems such as the tendency to fall or dementia disorders.
There is usually less mention of mental disorders in the elderly, which, first of all, may appear only in old age, and they can be - both for the caregivers and the patient - an incredible burden. One of such problems that may lead to more serious difficulties in the life of a senior is psychotic disorders in old age.
Elderly psychotic syndromes: causes
Psychotic syndromes of old age can be caused by various disorders in the field of psychiatry as well as various somatic diseases. In the case of the first of these, psychotic symptoms may be accompanied, among others, by affective disorder (disordermood) such as depression and bipolar disorder. In such a situation, the elderly patient is diagnosed with e.g. depression or mania with psychotic symptoms.
It is also possible that the elderly psychotic syndrome will appear in a senior due to schizophrenia. It happens that this mental illness does not appear for the first time until late in life. However, such a situation is quite rare - it is much more common that a patient suffered from schizophrenia in his youth and was treated for it until remission occurred. Unfortunately, there is a possibility that - even despite many years without any psychotic symptoms - the elderly will relapse and develop an elderly psychotic syndrome.
Another cause of psychotic symptoms in the elderly may be Alzheimer's disease. This unit is typically associated with memory impairment, but the truth is that even half of all patients with it may develop symptoms of psychosis.
The sudden appearance of a psychotic syndrome in a senior may be the result of delirium. This problem has various causes, as it can be caused by an infection (e.g. urinary tract infection or pneumonia), sudden discontinuation of previously taken medications for a long time (e.g. benzodiazepines) or exacerbation of a chronic disease the patient suffers from (e.g. chronic obstructive disease). lung disease or liver failure). Delirium - and the associated psychotic symptoms - may also occur after surgery.
Elderly psychotic syndromes may also develop in connection with the use of various medications by the patient, not only psychotropic preparations. It happens that psychotic symptoms appear after a senior has taken antihistamines, anticholinergics or strong painkillers or sleeping pills.
Elderly psychotic syndromes: risk factors
There are several problems that exacerbate the possibility of a patient developing one of the psychotic syndromes of old age. I am talking about:
- female gender (this is more common in women)
- social isolation
- inability to move on their own (bedridden patients have a higher risk of senile psychosis)
- sensory disturbance (e.g. hearing or visual impairment)
Elderly psychotic syndromes: symptoms
Basic symptomsof the elderly psychotic syndromes are delusions and hallucinations. Delusions are incorrect beliefs, completely inconsistent with logic, the wrongness of which - even with the use of the most reasonable arguments - cannot be convinced of the sick person.
False judgments may have various topics, depending on the cause of the senior's psychosis (e.g. a patient with psychotic depression may express nihilistic delusions), but in general there are certain types of delusions that are particularly common in the course of elderly psychotic syndromes.
Seniors in psychosis are often convinced that someone is trying to hurt them or rob their home or that the apartment they have been staying in for years does not really belong to them and they are in a complete stranger place.
Interestingly, delusions in older people often involve infidelity - even after fifty years or more of a happy relationship, a patient who experiences psychosis may begin to accuse their loved one of cheating on him.
The second characteristic manifestation of old age psychotic syndromes are hallucinations. These are abnormal sensations regarding the sense organs, e.g. the patient may see things that are not really there (he experiences visual hallucinations then - Charles Bonnet syndrome) or hear voices when absolutely no one is talking to him (in such a situation, about auditory hallucinations).
In addition to those already mentioned, a senior with psychosis may experience other ailments, e.g. episodes of significant changes in behavior (in the form of, for example, strong psychomotor agitation).
It should be emphasized here that the term "syndromes" is used in the case of the discussed problem because in their course not only psychotic symptoms appear, but also other abnormalities.
For example, in Alzheimer's disease, a patient may experience hallucinations and express delusions, but also have memory impairment or difficulties in performing basic activities. In turn, in the course of schizophrenia, the patient may develop psychotic symptoms, but also such irregularities as shallowing of the emotions manifested or withdrawing from social relations.
Elderly psychotic syndromes: recognition
The diagnosis of the old age psychotic syndrome itself can usually be made quite quickly - the related abnormalities are so characteristic that the diagnosis is usually not difficult.
These appear, however, when the search for the causes of psychotic symptoms in an elderly person is started - as you can seeabove, there are quite a few of them, and therefore it is often necessary to conduct an extraordinary amount of research in order to find the problem responsible for psychosis.
Laboratory tests (which can, for example, detect elevated levels of inflammatory markers in the blood associated with pneumonia) or various imaging tests (mainly concerning the head) can be helpful. It is also always important to carefully analyze the state of he alth of a patient with elderly psychotic syndrome - after all, it is important both whether he suffers from any chronic diseases and what drugs he is taking.
Elderly psychotic syndromes: treatment
Finding the cause of the old age psychotic syndrome is absolutely crucial - in patients who develop this problem, it is first of all necessary to treat the underlying disease.
As for psychotic symptoms, the same drugs used for this purpose in other age groups can be used to control them - we are talking about antipsychotic drugs (neuroleptics).
It should be emphasized here that their implementation in elderly patients often causes some difficulties. First of all, care should be taken when determining the dose of the drug that is appropriate for the patient - firstly, they are usually lower than in young adults, and secondly, any possible increases in the dose of an antipsychotic in seniors should be much slower than in patients in younger age groups.
Older patients quite often take many different drugs from various drug groups - this should also be taken into account, because psychotropic drugs in general can interact with other drugs and some of these reactions can be simply dangerous, so you should also carefully analyze the choice of the drug so as to recommend the safest preparation to the patient.
It is also worth remembering that the elderly are more prone to the side effects of neuroleptics. Such can be, among others extrapyramidal symptoms (e.g. parkinsonism and dyskinesia), but also cognitive dysfunction. Problems of this kind may adversely affect the functioning of a senior, therefore - as has already been mentioned many times - treatment with antipsychotic preparations in this age group should be carried out with extreme caution.
About the authorBow. Tomasz NęckiA graduate of the medical faculty at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shore withheadphones in the ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.Read more from this author