Psychosis

Question 1

Is psychosis more or less common in old age?

Answer 1

The incidence of psychosis increases with age

Question 2

Early onset schizophrenia

Answer 2

• more common in females, lower incidence of family history of psychosis/lower genetic risk
• requires lower doses of neuroleptics
• A lot of the time those people with late onset had mild symptoms their whole life.
• These people don’t respond well to the drugs and also need to take lower doses
  High drug doses also increases fall risks
  -ex. Quatiapine at night lowers your bp so when you stand up after lying down you almost black out

Question 3

Delirium:

Answer 3

• Hallucinations are primarily visual…often accompanied by illusions (misperception of actual visual stimuli). Can be tactile or olfactory as well.
• Halmarks: acute onset, fluctuating LOC
• When you have someone with demenia, that’s real to them. It’s not going to get better, it’s not acute, so its okay to play into the delusion. “someone should get that kid out.’

Question 4

Charles Bonnet Syndrome

Answer 4

• Associated with low vision. Vivid hallucinations described as movie like
• Person is aware they’re hallucinating
  criteria:
  visual hallucination
  partially intact sight
  visual impairment
  lack of evidence of brain disease or other psychiatric disorder

Question 5

Primary psychosis

Answer 5

includes schizophrenia (and related disorder), psychotic depression, bipolar disorders, and delusional disorders. Early onset of psychosis suggests a primary cause.

Question 6

Secondary psychosis

Answer 6

is caused by delirium, psychotic symptoms associated with dementia, and psychotic symptoms secondary to a medical condition or chemical agent (drugs/alcohol). This type typically has a sudden and unexpected onset.

Question 7

Are typical or atypical better for treatment of psychosis in elderly?

Answer 7

Atypical better than typical for elderly due to less parkisonian side effects

Atypical antipsychotics such as risperidone, olanzapine, and quetiapine are typically the first-line antipsychotics used in pharmacotherapy. They selectively block specific dopamine and serotonin receptors, reducing both positive and negative symptoms, as well as helping stabilize mood and reduce cognitive impairment found in schizophrenia.

Atypical antipsychotics are less likely to cause side effects than typical antipsychotics.

Question 8

Treatment with meds:

Answer 8

1) phracol intervention to stop symptoms then
2) therapeutic strategies

Short-term - for psychosis with depression, mania, substance abuse-induced psychosis.

Use with caution, especially in those with dementia.

Lower doses due to physical changes with aging.

Consider fall risk, interaction with other medications, physical status and monitor carefully.

Monitor adherence/overuse….consider cognitive deficits and other factors that may interfere with proper use. Monitor effectiveness. If medication is not effective, it may suggest a physical, underlying cause for psychosis. Medications that are not effective should not be continued.

Question 9

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