Psychiatry Research EG

Age-related deterioration of significant cortical areas with associated neurochemical changes, comorbid physical illnesses, social isolation, sensory deficits, and polypharmacy leads to an increased risk of psychosis in the elderly [1]. The emergence of psychotic symptoms for the first time in later life poses a diagnostic challenge for clinicians assessing and treating elderly individuals with mental illness. In these situations, clinicians are frequently encounter comorbidity issues related to cognitive deficits, affective symptomatology, and physical illness [2]. The US Census Bureau released a report that states that -the population of individuals older than 65 years worldwide will triple by midcentury, from 516 million in 2009 to 1.53 billion in 2050 [3]. In Egypt, there has been a marked increase in the population of individuals older than 60 years of age, comprising 6% of the total Egyptian population, and is further expected to increase to 11.5% by the year 2025 [4]. This shift in the age structure of the world’s population poses challenges to society, families, businesses, healthcare providers, and policy makers in meeting the needs of aging individualsand also leads to an increase in economic burden because of increased disabilities, especially as there is an expected increase in the suffering of patients, families, and caregivers with almost up to 23% of this population expected to experience psychotic symptoms due to different causes, mainly dementia, at some point in their lives [5]. Dementia occurs in approximately 10% of individuals in their seventh decade and in 20–30% of individuals in the eighth and ninth decades. Symptoms of psychosis and agitation such as delusions, hallucinations, aggression, and disinhibition occur in about 50% of these patients, and are often challenging to caregivers [6]. It is not uncommon in many cases to have a family history of either dementia itself, or its precipitating factors, such as hypertension, diabetes, or other vascular or neurodegenerative diseases [7]. Woolley et al. [8] have reported in their study that almost 28.2% of individuals with a neurodegenerative disease were misdiagnosed and had received a previous psychiatric diagnosis mainly of psychosis. Moreover, delirium is more common in the elderly; 14–56% of patients in hospitals experience an episode during their stay. It is more prevalent where there is preexisting cognitive impairment but other common causes include infection (43%), prescribed medications (20–4%), and endocrine, fluid, and electrolyte imbalances [9]. Drug dependence resulting in induced psychosis in the elderly includes mainly alcohol and benzodiazepines [10]. In Egypt, with the increased longevity of life and changes in the family system toward nuclear families, together with the increased medical, psychiatric, and behavioral problems in the aged population, there is an enormous need to develop carefully designed plans for promotion of mental health among the elderly in Egypt [11].