late-onset schizophrenia
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Introduction
See schizophrenia
Epidemiology
- women affected more often than men
- preponderance of women increases as the age of onset increases
Pathology
- comorbidities more common
Genetics
- genetic influence may assume lesser importance with older age at onset
Clinical manifestations
- positive symptoms: no differences from early-onset form
- memory retention: no differences from early-onset form
- more likely to present as paranoid schizophrenia
- lesser negative symptoms
- less impairment in learning & abstraction
- greater prevalence of persecutory delusions in very late onset schizophrenia
- higher prevalence of visual & olfactory hallucinations
- auditory hallucinations, hearing people through walls
Complications
- frequent comorbidity of depression* with high risk of suicide in elderly with schizophrenia[1][6]
* elderly with chronic schizophrenia may grapple with Erikson's final stage of psychosocial development-integrity vs despair; they may find themselves in a state of despair; this is diagnosed as major depression with schizophrenia in later life[1]
Differential diagnosis
- psychosis & agitation in the elderly
- generally present several years after diagnosis of dementia
- delirium
- attention deficit
- hallucinations generally visual hallucinations
- delusional disorder
- absence of hallucinations
- schizoaffective disorder
- symptoms of depression or mania at least as prominent as psychotic symptoms
Management
- elderly with late-onset schizophrenia may respond to antipsychotics at a lower dose than that for younger patients
- amisulpride for very-late-onset schizophrenia-like psychosis[1][4]
- long-acting injectable antipsychotic agents may be superior to oral medications in reducing rehospitalization for older patients with schizophrenia[1][5]
- screening for depression with PHQ-9[1]
- see schizophrenia
More general terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ Howard R, Rabins PV, Seeman MV, Jeste DV. Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. The International Late- Onset Schizophrenia Group. Am J Psychiatry. 2000 Feb;157(2):172-8. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10671383
- ↑ Vahia IV, Palmer BW, Depp C et al Is late-onset schizophrenia a subtype of schizophrenia? Acta Psychiatr Scand. 2010 Nov;122(5):414-26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20199491 Free PMC Article
- ↑ 4.0 4.1 Howard R, Cort E, Bradley R et al. Amisulpride for very late-onset schizophrenia-like psychosis: the ATLAS three-arm RCT. Health Technol Assess. 2018;22(67):1-62 https://www.journalslibrary.nihr.ac.uk/hta/hta22670#/abstract
- ↑ 5.0 5.1 Lin CH, Chen FC, Chan HY et al. A comparison of long-acting injectable antipsychotics with oral antipsychotics on time to rehospitalization within 1 year of discharge in elderly patients with schizophrenia. Am J Geriatr Psychiatry. 2020;28(1):23-30 https://www.ajgponline.org/article/S1064-7481(19)30468-3/fulltext
- ↑ 6.0 6.1 Hoertel N, Jaffre C, Pascal de Raykeer R et al Subsyndromal and syndromal depressive symptoms among older adults with schizophrenia spectrum disorder: prevalence and associated factors in a multicenter study. J Affect Disord. 2019;251:60-70 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30904777 https://www.sciencedirect.com/science/article/abs/pii/S0165032718318470