A guide to psychosis in older people

Key points:

• Psychosis is not ‘insanity’ or ‘losing your mind,’ but symptoms such as hallucinations, delusions and paranoia should not be ignored by carers

• Drug-induced psychosis may be a leading cause of symptoms in older people, due to polypharmacy treatment or prolonged side-effects from medication, substance abuse or withdrawal

• A dementia or Alzheimer’s disease diagnosis may prevent people from addressing psychosis through misattribution

This Aged Care Guide will address psychosis and its associated symptoms in older people. In particular, this article covers symptoms of psychosis, possible causes of psychosis, caring for or recognising a psychotic episode and who to contact in case a situation escalates or warrants further intervention.

It is important to monitor the doses, potential polypharmacy interactions, food and nutritional balance, along with sleep and sleep quality in people at risk of psychosis.

Symptoms of psychosis

Symptoms of psychosis include agitation, hallucinations (auditory, sensory and visual), delusions, paranoia, delirium, mood swings and appearing vacant behind the eyes.

Although psychosis is typically associated with schizophrenia, which is a lifelong condition with symptoms first appearing around the age of 20 – 30 years, psychotic episodes can appear at any age. A psychotic episode is a period of disconnection from reality, which can last from a couple of days to a couple of months at most.

Many symptoms of psychosis may be hard to discern from other conditions, such as Alzheimer’s disease or dementia, as confusion, agitation and false beliefs or paranoia spurred on by memory loss can present in a similar way.

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.

Possible causes of psychosis

In addition to sleep disturbances, substance abuse disorder, adverse narcotic reactions, drug dependence or withdrawal — the way that medications interact with one another is one of the most common causes of psychosis in older people.

Of note, 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 elderly people is also of significant concern, as 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.

Findings from 2008 suggest that anti-psychotic medications, such as risperidone, which may be prescribed to people with Alzheimer’s disease can increase the short term hospitalisation and mortality rate by three-fold, with only a small selection of the medicines approved for treating the condition. Of particular note, anti-psychotic medications should be very selectively prescribed in cases where the person has Lewy bodies or Parkinson’s disease and dementia, due to the heightened risk of visual hallucinations.

Treatment for psychosis

Treatment for psychosis is dependent on existing medications, including a history with anti-psychotic medications, the level needed to stifle symptoms and the level of lucidity in the affected person.

In the rare instance an older person experiencing psychosis becomes violent or creates a disturbance which may endanger others, attempt to put them at ease, create distance and refer the matter to emergency services (paramedics via calling 000) in case of an incident arising.

There are many large organisations that provide assistance with mental health issues and help to find the right support for older age groups through counselling services or programs. These groups include:

• BeyondBlue
• Better Place Australia
• Black Dog Institute
• Head to Health (Government-run)
• Mental Illness Fellowship of Australia
• Dementia Australia
• MindSpot
• Macquarie University runs intervention programs for older Australians experiencing anxiety and depression

Related content:

The link between dementia and depression

Dementia

What types of respite care are there?