THE TREATMENT OF PSYCHOTIC DISORDERS IN LATE-LIFE

Objective: To review the epidemiology, phenomenology, and treatment of psychotic disorders in late life. Method: The literature relating to psychotic symptoms in the elderly is reviewed, with a focus on the fol lowing categories. primary psychotic disorders, mood disorders, deliri um, Parkinson's disease (PD), and somatic hallucinoses (including Char les Bonnet syndrome [CBS] and musical hallucinosis). Practical clinica l treatment implications are discussed. Results: The prevalence of psy chotic symptoms increases with age, largely because of underlying medi cal illnesses such as dementia, delirium, and other neurological disor ders that are exacerbated by sensory deficits coupled with social isol ation. Treatment with the traditional high-potency neuroleptics is com plicated by extrapyramidal symptoms, and sedation, postural hypotensio n, and anticholinergic effects complicate the use of low-potency tradi tional agents. Although clozapine may have a narrow use in treatment-r esistant schizophrenia and PD, it is poorly tolerated in the elderly. Risperidone has a wider use in this population and has a favourable cl inical profile (at low doses). Other new neuroleptics await more forma l evaluation in the elderly. Conclusion: Psychotic disorders in old ag e have more organic associations, which cause greater difficulty in th eir treatment. Further evaluation of the use of the atypical agents in this elderly group is indicated.