Welcome to the 22nd WCP Congress Program Scheduling

Abstract Body

There is an increase of the prevalence of psychotic symptoms in older adults. The presence at this period of life of the highest comorbidy rate, the changes of the central nervous system with ageing and the particular high frequency of life stressors during this period of life may all explain this. Psychotic symptoms are present in an important number of medical and psychiatric conditions and they make part of psychotic disorders in late life too. The same classification of disorders with psychotic symptoms in adults may be used for older adults. But the proposed classification presented, with the respective diagnostic criteria, may quickly changes next years with the publication in of the International Classification of Diseases, 11th revision, to which a working group of old age psychiatrists was invited to review the classification of psychotic disorders. A consensus statement proposed in 19981, in an arbitrary way, cut-offs with potential clinical and research utility. Psychosis diagnosed before 40 years should be classified as having an early onset; psychosis diagnosed between 40 and 60 years should be recognized as having a late onset. Psychosis diagnosed by the first time after 60 years should be recognized as having a very late onset.

Primary psychotic symptoms exist in persistent psychotic disorders (schizophrenia, delusional disorder, schizoaffective disorder), acute psychotic disorder and personality disorders (paranoid, schizoid and schizotypal personality disorders). Secondary psychotic symptoms include major and minor neurocognitive disorders, delirium, organic mental disorders, disorders due to psychoactive substance use, bipolar disorders and depressive episode. Somatic disorders and comorbidities, and iatrogenic causes included at this cluster. Assessment and management of psychosis in older adults at Primary Care require an organization of the mental health care system. The management of psychosis in older adults implies the proper use of multidisciplinary therapeutic interventions: pharmacotherapy and psychological, social and occupational therapy. All forms of stigma and discrimination against older adults with psychosis and their carers should be eliminated.

Howard R, Rabins PV, Seeman MV, Jeste DV and the International Late-Onset Schizophrenia Group. Late-Onset Schizophrenia and Very-Late-Onset Schizophrenia-Like Psychosis: an international consensus. Am J Psychiatry 2000; 157; 172-178.