Key Points

Psychotic symptoms are defined as either hallucinations or delusions. Hallucinations are perceptions without stimuli. Delusions are fixed, idiosyncratic, or false perceptions or beliefs with little if any basis in reality and are not the result of religious or cultural norms.
Hallucinations can occur in any sensory modality (ie, visual, auditory, tactile, olfactory, gustatory). In late life, multimodal hallucinations are common.
Delusions are unfounded ideas that can be suspicious (paranoid), grandiose, somatic, self-blaming, or hopeless. Delusions in late life are often paranoid or persecutory, such as a belief that one’s safety is in jeopardy or that one’s belongings are being stolen.
When psychotic symptoms arise in the context of depression or bipolar disorder, the symptoms are often “mood congruent,” eg, in depression, delusions that one is penniless or that one is already dead; in mania, grandiose delusions, elevated self-regard.
Psychosis occurring for the first time in late life is often due to dementia or neurologic conditions such as Parkinson’s disease or stroke, as opposed to a primary psychotic disorder, such as schizophrenia. Nevertheless, a de novo primary psychotic disorder in late life is not uncommon in women.