CLINICAL CASE DISCUSSION - THE ELDERLY PATIENT WITH PSYCHOSIS

Objective: To present a clinical case of an elderly person with psycho sis and to discuss associated diagnostic and treatment issues. Methods : A case from I of the authors' clinical practices was presented in En glish and French to several groups of Canadian psychiatrists attending a teaching day on psychosis. Three geriatric psychiatrists acted as f acilitators, soliciting the clinical experiences of the participants i n the discussion The authors integrated clinical content fr om these s essions with results of a Medline search on psychosis in elderly perso ns. Results: The assessment of elderly patients with psychosis is more often than in younger patients by overlying organicity, including del irium due to illness or medication use dementia, or sensory deficits. Treatment might further worsen cognitive, affective and functional imp airment through adverse effects such as extrapyramidal symptoms (leadi ng to decreased mobility and general functioning;), anticholinergic ef fects (predisposing to delirium), and hypotension (predisposing to fal ls). Newer antipsychotics with less hazardous side effect profiles hav e an increasing role, but they must be coupled with psychosocial suppo rt to maximize the patient's independent functioning and quality of li fe after discharge. Conclusions: Assessment and treatment of the elder ly person with psychosis must consider a wide variety of biopsychosoci al variables seeking to minimize further treatment-related deteriorati on. Controlled studies of antipsychotics in elderly people must be con ducted in a variety of diagnostic situations that reflect their actual use in the community and information must be propagated effectively a mong general psychiatrists, family physicians, and geriatric psychiatr ists. The role of nonpharmacologic interventions in elderly persons wi th psychosis is even less well understood and deserves further study.