Late-Onset Schizophrenia: A Review for Clinicians

Abstract

Although presumed to be relatively infrequent in presentation, the existence of late-onset schizophrenia (LOS) is now recognized by the International Consensus on Late-Onset and Very-Late-Onset Schizophrenia Group. In 2000, this group agreed upon ages 40 to 60 years as LOS cutoffs. This review is focused on identifying features of LOS that are important for clinicians working with middle-aged and older adults. Although the symptoms in LOS and early-onset schizophrenia (EOS) are more similar than different, patients with LOS tend to experience more positive and fewer negative symptoms. Specifically, persecutory and paranoid delusions and visual, tactile, and auditory hallucinations tend to be more prominent in patients with LOS than in patients with earlier onsets. Risk factors for the disease include sex (female) and social isolation. Current pathophysiological findings suggest that patients with LOS have enlarged ventricles and more white-matter hyperintensities when compared than age-matched patients with EOS and controls. Finally, treatment for LOS should include a combination of second generation antipsychotics administered at low dosages with small incremental increases as well as psychological therapies such as cognitive behavior therapy, social and functional skills training, and supported employment rehabilitation.

Keywords:

• interventions
• older adult
• psychiatric disorders
• psychosis
• serious mental illness