Diagnostic and therapeutical challenges of late-onset psychosis.

Gracia-García Patricia,

Abstract

We present a case report that fits on the concept of “paraphrenia” described as a chronic psychotic disorder in old age, in order to review the following teaching points: 1) Differential diagnosis to consider in "late-onset" psychosis include: Delirium; Drugs; Disease; Dementia; Depression or other affective disorders; and Delusional disorder or schizophrenia spectrum disorders; 2) “Late-onset” Psychosis have different clinical features whose specificity is not considered on current international diagnostic classification criteria; 3) Organic factors might play a significant role on “late-onset” psychosis, and diagnosis of cognitive impairment or dementia has to be considered; 4) The use of antipsychotics in old people has to be more cautious, and they show more problems of adherence to treatment than the general population; 5) Cognitive and social factors might overlap and contribute to a decrease of capacity on decision making in these patients.