Psychotic Disorders in Late Life

Abstract

The term “psychosis” has changed over time and become more specific. The earlier Diagnostic and Statistical Manuals of Mental Disorders (DSM-I and DSM-II) (American Psychiatric Association, 1952, 1968) made a distinction between “psychotic” and “nonpsychotic” organic brain syndromes based mainly upon severity. That terminology was abandoned in the initial version of DSM-III (American Psychiatric Association, 1980) and has not been restored. Thus, some patients we would now diagnose as having dementia would have been diagnosed as having a “psychotic” condition if the dementia was severe. It is interesting to note the further progression of this redescriptive process in DSM-IV (American Psychiatric Association, 1994). Here, the term dementia is not abandoned, but is characterized as a cognitive disorder. This definition takes us even further from the concept of psychosis as it is generally understood, implying severe disorganization of the personality. The term psychosis in current usage is now mainly restricted to schizophrenia and bipolar disorder. The DSM-IV does not specifically characterize bipolar disorder as psychotic and limits that term to schizophrenic, schizoaffective, and delusional disorders. This chapter adopts that convention, but we will briefly consider psychotic features, notably delusions and hallucinations, that are frequently associated with some forms of dementia. We will deal largely with schizophrenia. A detailed presentation of late-onset psychotic conditions and schizophrenia in old age is contained in a volume by Miller and Cohen (1987) to which the reader is referred for more detailed information than can be presented here. It is noted that while schizophrenia may be a life-shortening disease, many schizophrenic patients live relatively long lives and may continue to suffer from symptoms of the disorder throughout those lives.