Psychotic symptoms in patients with medical disorders

Psychotic symptoms frequently occur in patients with comorbid medical disorders and present a diagnostic and treatment challenge. They may be a part of an independent psychiatric illness associated with the underlying medical condition or induced by substance use or medications. The presence of psychotic symptoms can contribute to misdiagnosis or complicate the management of the comorbid medical illness. Psychiatrists must be familiar with the assessment and management of psychotic disorders in patients with comorbid medical disorders. Medications that may be used to treat psychosis include antipsychotic agents, benzodiazepines, or possibly certain anticonvulsants. Selecting the appropriate medication requires knowledge of the pharmacokinetics of different agents and their side effect profile. Understanding the neuropsychiatric effects of medications and drug-drug interactions may help in preventing psychotic symptoms.

Use of psychopharmacologic agents in the elderly

Most psychiatric disorders in elderly patients are amenable to treatment, provided that intervention is thorough and intensive. Appropriate and judicious use of psychopharmacologic agents has a potential for dramatically improving the quality of life and functional status of many elderly patients with psychiatric disorders. The decision to prescribe a psychopharmacologic agent in elderly patients is a serious and complex issue. Several basic principles need to be followed (Table 6). Although some strides have been made in the last decade regarding safety and efficacy of many psychopharmacologic agents in elderly [table: see text] patients, for many psychopharmacologic agents, large randomized controlled studies to evaluate efficacy and safety in elderly patients are lacking. Sparse data are available regarding the long-term effects of psychopharmacologic agents in elderly patients. Important gaps remain in our knowledge concerning the optimal duration of treatment for most psychiatric disorders in elderly patients. The treatment data deficiency is most striking among the oldest old (patients aged 85 and older), frail medically ill elderly patients (such as nursing home residents), and ethnic minority groups. Future research should focus on these and other relevant issues related to the use of psychopharmacologic agents in elderly patients.