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Delusions, hallucinations, and other psychotic symptoms can accompany a variety of conditions in late life. These symptoms may be more common than previously thought; Swedish investigators found that in a sample of individuals age 85 years, the prevalence of psychotic symptoms was 10.1%, with 6.9% of subjects having hallucinations, 5.5% having delusions, and 6.9% having paranoid ideation (Östling and Skoog 2002). Conditions causing acute psychotic symptoms that tend to resolve when the underlying condition is treated are discussed elsewhere in this textbook (e.g., delirium in Chapter 7, “Delirium,” and drug-induced psychosis in Chapter 20, “Psychopharmacology”). In this chapter, we review the epidemiology, presentation, and treatment of chronic late-life psychotic disorders that are not secondary to a mood disorder or a general medical condition other than a neurocognitive disorder. These include early-onset schizophrenia, late-onset schizophrenia, very-late-onset schizophrenia-like psychosis (VLOSLP; onset after age 60 years), delusional disorder, and psychosis related to a major neurocognitive disorder such as Alzheimer’s disease (AD).
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