Psychosis in Older Adults
by Linda J. Keilman, DNP, GNP-BC, FAANP
Psychosis is the presence of delusions, disorganized thinking, disorganized or abnormal motor behavior, hallucinations, or negative symptoms (American Psychiatric Association, 2013).
Psychosis is a loss of connection to reality and is quite common in older adults, especially at the end of life or those living with dementia.
The etiology in older adults can also be related to a variety of conditions or diseases as well as prescribed or illicit drug use. Psychosis can be a primary diagnosis but 60% of the cases are secondary to neurologic or medical conditions (Morgan, 2017). Most often, the older adult will have changes in behavior before psychosis develops.
The APRN should be aware of the following early warning signs (National Institute of Mental Health, 2016):
- Difficulty concentrating or thinking
- Unease with others, suspiciousness, paranoid ideation
- Apathy or hyperactivity with unfocused ideas or plans
- Self-neglect related to hygiene and appearance
- Difficulty differentiating fantasy from reality
- Trouble communicating or confused speech
A thorough and careful history, along with a complete physical examination, should be implemented if older adult patients present with any of the above warning signs. Accurate assessment skills will help lead to early diagnosis and treatment of underlying conditions and prevention of psychosis.
Linda J. Keilman, DNP, GNP-BC, FAANP
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Morgan, S. (2017). Psychotic and bipolar disorders: Behavioral disorders in dementia. FP Essentials, 455, 18-22.
- National Institute of Mental Health. (2016). Fact sheet: Early warning signs of psychosis. Bethesda, MD: National Institutes of Health.