Reality Bites

Psychosis in the elderly. It's a thing!

In Season 3 of Succession, one of the plot points involves family patriarch Logan Roy having a psychotic break because of a urinary tract infection. This leaves his children to (badly) negotiate a major deal. Spoiler alert: Logan is not happy with them once his symptoms resolve.

Unlike the Roy siblings, the Logue siblings shine in a crisis. Thank you very much.

I’ve been asking around and have learned that a lot of people have dealt with a psychotic break in an elderly relative. There are a lot of causes and plenty of academic articles on the phenomenon. Psychosis itself is defined as “the misinterpretation of the nature of reality, which is reflected in impaired perceptions and interpretation of the environment, false beliefs, and disorganized patterns of speech and behavior. In clinical practice the word ‘psychosis’ is commonly used to describe a severe mental illness in which delusions and hallucinations are prominent.” That’s from an article entitled Treatment of Psychosis in Elderly People, published in Advances in Psychiatric Treatment in 2005.

If your father is convinced that there’s a dead cat under his chair, your roommate is packing for a trip to visit a dead relative, or your grandmother calls the radio station to ask them to turn off the music in her head, you’re probably dealing with a psychotic break.

Common reasons for a person to show psychotic symptoms include dementia, metabolic changes (like infections), social isolation, sleep deprivation, dehydration, sensory deficits such as hearing loss, drug interactions, and drug reactions. It’s not a big surprise that someone whose metabolism is changing, who is having trouble with sight or hearing, and who is taking a lot of medication might have an unusual response to the world, especially if dementia is also a concern.

So what do you do if someone you know has clearly broken with reality? Get them to the ER. If the patient is violent or uncooperative, you may need to call an ambulance. If you can, pack up all of their medications, including over-the-counter drugs and vitamins, and bring them with you. You’ll be sent to the ER’s psych ward where the staff will help calm the patient, then work on identifying the cause. In most cases, treating the infection or discontinuing the problematic medication will resolve the situation right quick. In some situations, the doctor will prescribe anti-psychotic medications, but that’s not always necessary.

Finally, if you need to negotiate a deal while the medical team is working on your loved one, take the time to identify your Best Alternative to Negotiated Agreement. You don’t need to hand over as many board seats as Shiv Roy did in Succession.