Mental Health Monthly #10: The Elderly Psychotic Patient

Dr. Kim Nordstrom, a practicing emergency psychiatrist and associate professor with the University of Colorado, discusses various work-up models alongside valuable bedside tools for elderly patients with acute psychosis. In this podcast, she explores the methods to differentiate primary psychiatric psychosis from medically mediated psychosis in the elderly using an empirical bedside tool. Furthermore, Dr. Nordstrom educates our listeners on the treatment modalities available and currently recommended for new psychosis in the elderly.

 

Key Points:

 

• Non-psychiatric causes of psychosis include lobar degeneration, sensory deficits, pharmacologic mediators, and others. 
• ADEPT tool, developed by CPE under an ACEP sponsorship, is a useful guideline for rapid and reliable assessment of psychosis in the elderly. 
• DTS (delirium triage screen) tool, embedded in the ADEPT, is 98% sensitive to rule-out delirium.
• BCAM (brief concussion assessment method) is used if DTS is positive to rule-in delirium with high specificity.

 

ADEPT Tool: https://www.acep.org/patient-care/adept

 

DTS Tool: http://eddelirium.org/delirium-assessment/dts-calculator/

 

BCAM Tool: http://eddelirium.org/delirium-assessment/bcam-calculator/

 

Source: Shen​vi C, Kennedy M, et al. Managing delirium and agitation in the older emergency department patient: The ADEPT Tool. Ann Emerg Med. 2020 Feb; 75(2): 136–145.