Late-Onset Psychosis; Is It Real?

The nature of late-onset psychosis in the absence of a dementia or secondary to organic dysfunctions in the fifth decade of life and beyond is contentious and unresolved. Different terminologies, diagnostic criteria and age cut-offs have been applied to late-onset psychosis, which have stymied clinicians and researchers. No official diagnostic designation for patients with late-onset psychosis is included in the current psychiatric diagnostic system (Diagnostic and Statistical Manual of Mental Disorders-V, International Classification of Diseases-10). The validity of this diagnostic exclusion has been questioned. Despite these problems, a relatively consistent clinical picture has reported. However, many questions remain regarding the underlying etiology, pathophysiological mechanisms, treatment and prognosis. Whether late-onset psychosis is distinct from schizophrenia and whether it might be a harbinger of dementia are unclear. Recent studies have suggested an underlying biological pathophysiology of late-onset psychosis.

Chronic subdural haematoma presenting as late onset psychosis

This case report highlights a case of late onset psychosis which was an uncommon occurrence to psychiatric services in developing countries. Medical causes of late onset psychosis, though known, are often missed. Chronic subdural haematoma (CSDH) is predominantly a disease of the elderly. A history of direct trauma to the head is usually absent. Methods: A previously healthy 80-year-old male presented with 4 months duration of late onset psychosis. Result: Neurological examination was normal. Routine investigations were within normal limits and MRI brain revealed a chronic subdural haematoma. Owing to his age and small size of the haematoma, patient was not operated on and showed improvement with the pharmacologic treatment for psychosis. Conclusion: Detailed longitudinal history, clinical examination, investigations along with high index of suspicion is necessary to effectively manage this condition. As CSDH is known as a great imitator and is usually a disease of the elderly, it should be kept in mind while dealing with cases of late onset psychosis.