Late-Onset Psychosis

Objective-Although psychotic disorders usually manifest in young adulthood or middle age, some psychotic patients present psychotic symptoms for the first time in late life. The concept and diagnosis of late-onset psychosis have changed over the years. The authors review the clinical features, epidemiology and treatment of late-onset psychosis, with particular emphasis on lateonset schizophrenia. Methods-The authors conducted a MEDLINE literature review. Reviews, textbooks and some clinical studies about late-onset psychosis which were published in the literature were reviewed. Results-Although, in general, patients with late-onset schizophrenia have similar symptoms to those with early-onset schizophrenia, they are more likely to complain of hallucinations, persecutory delusions and partition delusions, and they are less likely to display formal thought disorder, affective flattening or blunting than their earlier-onset counterparts. Like early-onset schizophrenia patients, late-onset schizophrenia patients exhibit nonspecific structural changes in the brain. Although the exact prevalence of late-onset schizophrenia is not yet known, the 1-year prevalence rate of late-onset schizophrenia was found to be less than 1%. There is no trial-based evidence to help guide the choice of drug, however a number of special considerations are necessary when managing elderly patients. Conclusions-In the past few years, late-onset psychosis has begun to arouse the interest of psychiatrists, with research into late-onset schizophrenia being a relatively recent endeavor. The diagnosis and treatment of psychotic symptoms in elderly patients requires more than just extrapolation from that of young patients. There is a necessity for further researches involving Korean late-onset psychosis patients.