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New Research on Psychosis in Older Adults
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New Research on Psychosis in Older Adults

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Mental Health and Psychosocial Well-being".

Deadline for manuscript submissions: 30 June 2027 | Viewed by 3249

Editors

Dr. Katarzyna Broczek

E-Mail Website
Guest Editor
Mazovia Branch, Polish Society of Gerontology, 01-826 Warsaw, Poland
Interests: internal medicine; geriatrics; psychogeriatrics; medical rehabilitation
Special Issues, Collections and Topics in MDPI journals
Dr. Tomasz Krzysztof Szafrański

E-Mail
Guest Editor
Wolski Mental Health Center, 01-211 Warsaw, Poland
Interests: psychiatry; psychogeriatrics; education in psychiatry

Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute your valuable knowledge to the Special Issue of Healthcare dedicated to new research on psychosis in older adults. Psychotic symptoms may accompany various clinical entities, including delirium, dementia, depression, bipolar disorder, and late-onset schizophrenia. Interrelationships between somatic and psychological determinants of mental health in older age make psychosis in older adults a multidimensional and multidisciplinary area of research and clinical practice. Aging of the population and increasing use of healthcare services by older adults worldwide justify the urgent need to develop guidelines for the diagnosis and treatment of psychosis for emergency services, family medicine, and long-term care.

This Special Issue aims to address the issue of psychosis in older adults in a wide spectrum of scientific and practice-oriented approaches applicable to various levels of healthcare. Understanding the bases and trajectories of psychotic symptoms as well as including cultural, social, and linguistic aspects of psychosis may support the development of personalized therapies. Including the perspective of older individuals affected with psychotic disorders might be a valuable but often overlooked clue to the optimal treatment.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following: risk factors for psychotic disorders in older adults, diagnostic tools, symptomatology and differential diagnosis of psychotic symptoms in older adults, guidelines for diagnosis and treatment of psychosis in emergency services, therapeutic options in old age psychosis, non-pharmacological approaches to psychotic disorders, patient’s perspective, and education of medical staff to prevent, diagnose, and treat psychosis.

We look forward to receiving your contributions.

Dr. Katarzyna Broczek
Dr. Tomasz Krzysztof Szafrański
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • psychotic disorder
  • delirium
  • agitation
  • neurocognitive decline
  • psychological and behavioral symptoms of dementia
  • late-onset schizophrenia
  • mania
  • geriatric psychiatry

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Published Papers (4 papers)

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Research

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20 pages, 1207 KB  
Article
From Sensory Deprivation to Psychosis: Environmental Mechanisms of Delirium in Dementia—An Eight-Year Retrospective Longitudinal Case Report and Narrative Review
by Paulina Teodorczyk and Anna Różańska-Walędziak
Healthcare 2026, 14(17), 2705; https://doi.org/10.3390/healthcare14172705 - 25 Aug 2026
Abstract
Background/Objectives: Delirium in patients with dementia is a multifactorial condition traditionally attributed to acute medical triggers. However, emerging evidence suggests that non-biological factors, including sensory deprivation and environmental instability, may contribute to delirium vulnerability, particularly in vulnerable populations. To explore the temporal [...] Read more.
Background/Objectives: Delirium in patients with dementia is a multifactorial condition traditionally attributed to acute medical triggers. However, emerging evidence suggests that non-biological factors, including sensory deprivation and environmental instability, may contribute to delirium vulnerability, particularly in vulnerable populations. To explore the temporal associations between non-biological and environmental factors, particularly sensory deprivation and recurrent delirium in a patient with advanced Alzheimer’s disease and progressive vision loss, a narrative review was conducted. Methods: A narrative review of the literature on delirium risk factors, differential diagnosis, and non-pharmacological interventions was conducted. A retrospective longitudinal case report of a patient with advanced Alzheimer’s disease and progressive visual impairment, based on an eight-year observation, was used to contextualize the literature findings. Results: The literature indicates that delirium arises from the interaction between predisposing factors, such as cognitive impairment and reduced cognitive reserve, and precipitating factors, including both biological and environmental stressors. Sensory deprivation, particularly visual impairment, may significantly disrupt orientation and increase reliance on internally generated perceptual content, predisposing to hallucinations and delusions. Environmental instability, such as changes in caregivers, disrupted routines, and overstimulation, may further exacerbate this vulnerability. Evidence suggests that these factors may contribute to delirium even in the absence of identifiable classical medical triggers. In the presented case, individualized non-pharmacological interventions based on structured routines, environmental predictability, and sensory-adapted engagement were associated with periods of improved behavioral stability. Conclusions: The present case supports the hypothesis that delirium in dementia may involve impaired environmental integration, particularly in the context of sensory deprivation, in addition to established biological mechanisms. Person-centered non-pharmacological strategies aimed at maintaining familiarity, environmental predictability, and appropriate sensory support may represent valuable components of delirium prevention and management. These hypothesis-generating observations require confirmation in prospective studies involving larger patient populations. Full article
(This article belongs to the Special Issue New Research on Psychosis in Older Adults)
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22 pages, 867 KB  
Article
Epidemiology of Severe Mental Disorders in Older Adults: A Population-Based Longitudinal Study in Aragón, Spain
by Alicia Muñoz-Segovia, Irene Gómez-Latorre, Iris Martín-Peña, Clara Vivó-García, Laura Lafarga-Molina and Josep-Oriol Casanovas-Marsal
Healthcare 2026, 14(17), 2687; https://doi.org/10.3390/healthcare14172687 - 24 Aug 2026
Abstract
Background/Objectives: Mental disorders represent a major public health challenge, particularly in ageing populations. This study aimed to analyse the incidence of mental disorders requiring hospital admission in Aragón (Spain), compare the epidemiological and clinical characteristics of adults aged ≥65 years with the overall [...] Read more.
Background/Objectives: Mental disorders represent a major public health challenge, particularly in ageing populations. This study aimed to analyse the incidence of mental disorders requiring hospital admission in Aragón (Spain), compare the epidemiological and clinical characteristics of adults aged ≥65 years with the overall adult population, and evaluate temporal and geographical variations in incidence. Methods: A retrospective population-based study included all incident cases of mental disorders requiring hospital admission in Aragón between 2021 and 2024. Data from the Aragón Healthcare Big Data Platform (BIGAN) were analysed using descriptive statistics, multivariable logistic regression, and Poisson regression. Results: A total of 3057 incident cases were identified. The average annual incidence was 57.12 per 100,000 inhabitants in the overall adult population and 51.70 per 100,000 among adults aged ≥65 years. Older adults were more frequently women and showed higher rates of disability, polypharmacy, mood disorders (F3), and organic mental disorders (F0), whereas schizophrenia spectrum disorders (F2) and readmissions were less frequent. Organic mental disorders (OR = 12.28), mood disorders (OR = 2.50), disability (OR = 3.50), and polypharmacy (OR = 6.88) were independently associated with older age. Incidence remained relatively stable but showed geographical variation, with higher rates among older adults concentrated in predominantly mountainous counties. Conclusions: Adults aged ≥65 years showed an average annual incidence comparable to the overall adult population but exhibited a distinct clinical and geographical profile. These findings support integrated, age-sensitive, and territorially adapted mental healthcare strategies for ageing populations. Full article
(This article belongs to the Special Issue New Research on Psychosis in Older Adults)

Review

Jump to: Research, Other

24 pages, 679 KB  
Review
The Utility of Addenbrooke’s Cognitive Examination III (ACE-III) in Differentiating Neurodegenerative Disorders with Psychotic Symptoms: A Narrative Review
by Anna Barczak
Healthcare 2026, 14(10), 1313; https://doi.org/10.3390/healthcare14101313 - 12 May 2026
Viewed by 961
Abstract
Psychotic symptoms, including delusions and hallucinations, frequently complicate the course of Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), Parkinson’s disease dementia (PDD), and frontotemporal dementia (FTD). Their presence accelerates decline, worsens outcomes, and complicates management. Cognitive screening in such patients is essential [...] Read more.
Psychotic symptoms, including delusions and hallucinations, frequently complicate the course of Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), Parkinson’s disease dementia (PDD), and frontotemporal dementia (FTD). Their presence accelerates decline, worsens outcomes, and complicates management. Cognitive screening in such patients is essential yet challenging due to attentional fluctuation, impaired insight, and diagnostic overlap. Addenbrooke’s Cognitive Examination III (ACE-III) is a multidomain tool with higher sensitivity than the MMSE. Evidence indicates that ACE-III captures disorder-specific cognitive-psychotic profiles: memory impairment in AD with delusions of theft, visuospatial and attentional deficits in DLB with hallucinations, or executive dysfunction in FTD with paranoid ideation. Mini-ACE (M-ACE), a shorter derivative, is useful in acute psychiatric or advanced dementia settings. This review synthesizes evidence on ACE-III and M-ACE in psychosis-related neurodegeneration, highlights their role in differentiating from primary psychiatric psychoses, and identifies knowledge gaps, particularly in atypical AD variants, mixed dementia, and autosomal dominant AD. ACE-III emerges as a practical and informative tool, but psychosis-specific normative data and longitudinal studies are needed. Full article
(This article belongs to the Special Issue New Research on Psychosis in Older Adults)
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Other

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22 pages, 2148 KB  
Systematic Review
Antipsychotic Medications in Parkinson’s Disease Psychosis; A Systematic Review of Double-Blind, Randomised, Placebo-Controlled Trials
by Christopher John McKeown and Alberto Salmoiraghi
Healthcare 2026, 14(5), 698; https://doi.org/10.3390/healthcare14050698 - 9 Mar 2026
Viewed by 1256
Abstract
Background: Psychosis is a common neuropsychiatric symptom associated with Parkinson’s disease (PD), with prevalence rates of up to 75% over the course of the disease. Parkinson’s disease psychosis (PDP) is associated with increased morbidity, caregiver burden, depression, poorer quality of life and progression [...] Read more.
Background: Psychosis is a common neuropsychiatric symptom associated with Parkinson’s disease (PD), with prevalence rates of up to 75% over the course of the disease. Parkinson’s disease psychosis (PDP) is associated with increased morbidity, caregiver burden, depression, poorer quality of life and progression of dementia. It has also been shown to be a strong predictive factor for long-term care placement, and results in up to 71% increase in risk of mortality compared with PD patients free from psychotic symptoms. Use of APs for PDP is common, with up to 35% of PD patients prescribed at least one AP within 7 years of PD diagnosis. Methods: Four electronic databases (Ovid MEDLINE, Embase, PsycINFO, PubMed) were systematically searched for double-blind, randomised, placebo-controlled clinical trials for the use of APs in the treatment of PDP and their effects on PD motor symptoms, according to PRISMA guidelines. Results: Eleven studies from ten publications were identified and included in this review. Four studies investigated quetiapine, three investigated olanzapine, two investigated clozapine and a further two investigated pimavanserin. Quetiapine showed no significant improvement for PDP over placebo in three of the four studies, with both olanzapine studies also showing no improvement. Olanzapine studies also showed significant motor worsening compared to placebo. Clozapine significantly improved psychosis compared with placebo in both studies, with large effect sizes in primary outcome measures; (−0.82, 95% CI −1.37 to −0.26), −0.89 (95% CI −1.42 to −0.36). Pimavanserin also showed significant improvement (−0.48, 95% CI −0.77 to −0.18). Quetiapine, clozapine and pimavanserin showed no significant worsening in motor scores compared with placebo groups. Conclusions: Data from the studies included in this review suggest that the use of quetiapine for the management of PDP may not be evidence based. Clozapine may improve PDP symptoms with low doses however significant side-effects may limit usability. The findings from this review support the use of clozapine as an alternative AP for the management of PDP when clinically appropriate. Full article
(This article belongs to the Special Issue New Research on Psychosis in Older Adults)
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