Psychotic downswing in the elderly: A way to express desire

Old age, with the accompanying physical transformations and social modifications, is a period requiring a psychical reorganization. This reorganization will help the elderly to cope with everyday life. Many events put the elderly to the test. Some elderly persons will have enough strength to affront these events with a certain amount of support from a stable environment. Others will need to be helped and will ask for help. But for some elderly people this situation will be a drama, which disrupts the bio-psycho-social order and may entrain different disorders including a massive withdrawal blocking the psyche and leading to its annihilation or delirious behaviour evoking a diagnosis of psychosis with a well-known pernicious effect. The frequency of depression associated with somatic diseases is known to be high. Psychotic symptoms are essentially delusions leading toward paranoiac delirium. The main signs of these disorders are disturbances that usually require sedation. The author suggests leaving room for patient's expression and, via the psychotherapy of a 78-year-old patient, shows that human beings exist with their own transmissible history. The author then analyses the sense of the delirium trouble in order to optimize the treatment taking into account all clinical features. (C) 2010 Elsevier Masson SAS. All rights reserved.