This article reviews diagnostic and treatment issues which merit special consideration in the elderly psychotic patient. Psychoses are serious psychiatric disorders and can present in different forms in the elderly. The important ones include schizophrenia, psychosis in patients with dementia, psychosis in patients with depression and delusional disorder. Typical and atypical antipsychotic medications remain the treatment of choice for psychotic disorders but special considerations are warranted when prescribed to elderly patients. We have highlighted differences between younger and older adults in terms of clinical characteristics and treatment of psychotic disorders.