Focus on psychosis in older people
The risk of psychosis increases with age and other health conditions can make things worse. But treatment and support are available.
Key Points
People with psychosis may experience hallucinations or delusions.
Symptoms may be hard to discern from dementia and some other conditions.
If you have concerns, seek advice from a qualified and registered health professional.
About one in every 200 adult Australians will experience a psychotic illness each year. The risk increases with ageing, often due to the mixing of medications. But that’s not the only cause.
People with psychosis (also known as a “psychotic episode”) cannot tell what is real and what is not. They have difficulty with the way they interpret the world around them, and their thinking can be confused.
They may experience hallucinations, such as hearing voices, or have delusions — false beliefs about themselves or the world around them.
Psychosis can be very frightening for the person experiencing it. In severe cases, someone with psychosis may be at risk of self-harm, or harming others.
Psychosis is common in Alzheimer's Disease with approximately 41% of people with the disease experiencing symptoms. Huntington's disease, Parkinson's disease or multiple sclerosis may also contribute to the onset of psychosis or a psychotic episode through disturbances to sleep, impacting the brain's ability to function properly. Psychosis is a set of symptoms and the difficulty is discerning what disease or diseases are causing it. Alzheimer's disease is often one of them.
Huntington’s disease, Parkinson’s disease, or multiple sclerosis may contribute to the onset of psychosis or a psychotic episode through disturbances to sleep, impacting the brain’s ability to function properly.
The Royal Australian College of General Practitioners (RACGP) advises GPs to be especially diligent when treating seniors, who are more likely to have several concurrent health issues, or comorbidities.
“Psychotic symptoms arise in the elderly in four clinical situations: mood disorder (either depression or mania), schizophrenia (either early onset or late onset), dementia, and delirium.
“As comorbidity rises in frequency with age, general practitioners will encounter complex combinations of disorders (eg., Dementia complicated by delirium, or schizophrenia complicated by dementia).
“Disentangling these presentations requires a good knowledge of the patient’s history, a competent mental state examination, and appropriate medical work ups.”
The way that medications interact with one another is a common cause of psychosis in older people.
Mixing and matching the following medications may lead to nasty side-effects if unchecked by a medical professional:
Stimulants (narcolepsy medications, weight loss medications, attention-deficit medications).
Anti-depressants (selective serotonin reuptake inhibitors — SSRIs, anti-anxiety medications, anxiety disorder medications, tremor or associated medications).
Antihistamines.
Anti-inflammatory medications.
Anti-psychotic medicines.
Post-operative psychosis in older people can also be of concern. People who are sedated before or feel groggy after cannot be medicated to treat potential psychosis thereafter. As people age, the likelihood of operations that would induce psychosis increases.
Research also shows that too much dopamine may be associated with psychosis. Dopamine is one of the chemicals in the brain that sends information from one brain cell to another.
Having high levels of dopamine could interrupt the pathways in the brain responsible for memory, emotion, social behaviour, and self-awareness.
More information about medications and older people is available here.
Treatment usually involves a combination of:
Medicine/s
Education about the illness (psychoeducation)
Psychotherapy or counselling
Community support programs
Family support
Practical support.
Medicine
Antipsychotic medicines work by altering chemicals in the brain, including dopamine. Antipsychotics usually take several weeks to reduce symptoms such as hallucinations or paranoia, but they may immediately produce a calming effect and help the person with difficulties getting to sleep.
Antipsychotic medicines may cause side effects. It is important to find the right medicine or combination of medicines for each person.
Psychological therapy
Treatments depend on the needs of the people who are experiencing psychosis:
Supportive psychotherapy
Family therapy and peer support groups.
Community support groups
These organisations provide assistance with mental health issues and can find support for older people through counselling services or programs:
Head to Health (Government-run)
Macquarie University offers intervention programs for older Australians experiencing anxiety and depression.
The elderly are more vulnerable to complex combinations of medical and psychiatric problems that require painstaking efforts to disentangle and manage appropriately.
Here are some common scenarios, as provided in advice to doctors from the Royal Australian College of General Practitioners:
- About 5–10% of dementias are complicated by major depression that presents principally with anxiety, agitation, insomnia, and poor appetite. It must be distinguished from the “sundowning” that arises commonly in mid-stage dementia.
- Patients with dementia are especially vulnerable to delirium. Look for sudden changes in mental state and behaviour.
- If patients with long-standing psychotic illnesses develop dementia, doses of antipsychotic medications may need to be reduced.
Disclaimer: This article is for informational purposes only and should not be considered medical advice. Consult a healthcare professional about any health concerns or before making any changes to your medication, diet, or exercise routine.
Related reading: RACGP, Health Direct, Aged Care Guide
