Colijn Mark A, Nitta Bradley H, Grossberg George T
From the Department of Neurology and Psychiatry, Saint Louis University School of Medicine.
Harv Rev Psychiatry. 2015 Sep-Oct;23(5):354-67. doi: 10.1097/HRP.0000000000000068.
Psychosis is relatively common in later life and can present in a wide variety of contexts, including early-onset and late-onset schizophrenia, delusional disorder, mood disorders, and various dementias. It can also occur as the result of numerous medical and neurological diseases and from the use of certain medications. Although identifying the cause of psychosis in older patients can be challenging, the unique clinical features associated with the different disorders can help in making the diagnosis. Accurate diagnosis of psychosis in older populations is essential, as its treatment varies depending on the context in which it appears. Despite the safety concerns regarding the use of antipsychotics in older patients, certain pharmacological treatments appear to be both efficacious and reasonably safe in treating psychosis in older populations. Additionally, although research is limited, numerous psychosocial therapies appear promising. This review summarizes the literature on the epidemiology, clinical characteristics, neuroimaging, and treatment of psychosis in later life, and serves as an update to past reviews on this topic.
精神病在晚年相对常见，可出现在多种情况下，包括早发性和晚发性精神分裂症、妄想障碍、心境障碍以及各种痴呆症。它也可能由多种医学和神经疾病以及使用某些药物引起。尽管确定老年患者精神病的病因具有挑战性，但与不同疾病相关的独特临床特征有助于做出诊断。准确诊断老年人群中的精神病至关重要，因为其治疗会因出现的情况而异。尽管在老年患者中使用抗精神病药物存在安全问题，但某些药物治疗在治疗老年人群的精神病方面似乎既有效又相对安全。此外，尽管研究有限，但许多心理社会疗法似乎很有前景。本综述总结了关于晚年精神病的流行病学、临床特征、神经影像学和治疗的文献，并作为对该主题以往综述的更新。
