Psychotic Disorders

Psychotic Disorders

The term psychoticgenerally refers to symptoms in which the individualis not in touch with reality. Psychotic symptoms are primarily hallucinations (perceptions of things that are not really there, such as hearing voices or feeling as though bugs are crawling all over one's body) and delusions (false beliefs that are maintained in the face of evidence that they are false, such as believing that one's children are trying to poison or steal from the individual). Approximately 10 percent of older adults admitted to psychiatric hospitals report psychotic symptoms that began after the age of 65 (Webster & Grossberg, 1998). The most common causes for these symptoms are dementia, sever depression, and various medical problems, such as infections or metabolic imbalances. Early in life, more men than women are admitted to hospitals with psychotic symptoms. However, more women than men are admitted with psychotic symptoms later in life, perhaps due to the protective effect of estrogen in the brain that declines after menopause. Following is a description of the two most common types of psychotic disorders among older adults.

Schizophrenia

Schizophrenia is the most chronic and severely disabling disorder, affecting every aspect of its victims' lives. It is very rare, occurring in only 1 percent of the general population. Onsetof the disorder typically comes in the early 20s for men and in the late 20s for women. Schizophrenia can also being later in life, though it is less common. Among patients hospitalized for schizophrenia, approximately 13 percent of them experienced the onset of the illness in their 40s, 7 percent in their 50s, and 3 percent after the age of 60 (Harris & Jeste, 1988). Women are 2 to 10 times more likely than men to develop late-onset schizophrenia (McClure, Gladsjo, & Jeste, 1999).

Contrary to popular belief, schizophrenia does not mean split personality. Symptoms of schizophrenia include: 

  • disorganized speech (such as absurd association nonsense words, illogical sentences)
  • disorganized behavior (such as wild gestures, aggressiveness)
  • negative (inactive) symptoms: deficiency of motivation, emotional expression, or speech
  • psychotic symptoms (hallucinations and delusions)

These symptoms often come in phases, with periods of active psychotic symptoms often preceded and then followed by periods of impaired daily functioning and strange ideas or behavior. Most people with schizophrenia do not return to their previous level of functioning and have increasing difficulty relating to people and managing life independently. People who develop schizophrenia in later life are more likely to be paranoid, but they generally function better than older adults with early-onset schizophrenia (McClure et al., 1999).

Treatment for schizophrenia largely involves managing psychotic symptoms through the use of medications (e.g., clozapine [Clozaril}, risperidone [Risperdal], zyprazadone [Zyprexa], quetiapine [Seraquil]) and building social skills. Some therapeutic programs focus on empowering individuals with schizophrenia to utilize their strengths and maximize productivity in the community. The latter programs are in their infancy for older adults. Most people with schizophrenia need a great deal of support to live in the community. Earlier in life, that support often comes from families, group homes, or psychiatric institutions. As adults age and families or group homes may no longer be able to care for complex psychiatric and medical needs, many with serious mental illness move to nursing homes. While staff are trained to treat a variety of medical illnesses, the vast majority lack training in treating and managing the behavioral symptoms of psychiatric problems, particularly with severe illnesses like schizophrenia.

Delusional Disorder

People with delusionaldisorder experience delusions in the absence of other symptoms. Among older adults, the most common delusion is that family or friends are trying to steal from or harm them (Webster & Grossberg, 1998). Since these delusions are often plausible at first, the beliefs are often not seen as a disorder or treated until long after onset of the illness (Thorpe, 1997). Delusionaldisorder is very rare, occurring in approximately 0.02 percent of the general population (Andreason & Black, 2001). The prevalence of delusional disorder increases in middle and late adulthood, however, with rates as high as 4 percent (Christenson & Blazer, 1994). Treatment of delusional disorder is very difficult. Antipsychoticmedications and psychotherapy are often unsuccessful in resolving the delusions, although psychotherapy can help the older adult cope with the distress caused by the delusions.

The above information was provided by the Society of Certified Senior Advisors (SCSA)