Dr. Ballas Answers: Late-Onset Schizophrenia
Hi everyone, welcome back to my blog. This time I wanted to discuss late-onset schizophrenia, a topic that’s of interest to me because usually the people I work with who have the disease tend to be fairly young. However, when I do consults in the general hospital, I’m confronted with severe psychotic symptoms in the elderly on a regular basis. Usually these symptoms are due to some sort of medical illness like a urinary tract infection, and are often accompanied by disorientation and problems concentrating. Late-onset schizophrenia doesn’t usually have these additional symptoms and also have several unique characteristics that warrant discussion. I hope you find this entry of interest and I look forward to any questions you may have about it.
Most people who have schizophrenia first start experiencing symptoms in their early teens to twenties, however a significant minority of people do not start experiencing symptoms until much later in life. Many experts ascribe to the notion of late-onset schizophrenia as an illness which begins after the age of 40 and consist of about 23% of all cases of the disease. Very-late-onset schizophrenia-like psychosis or what used to be called "late paraphrenia" has been described in which symptoms appear after age 60. There aren’t many studies that have measures how many people first get symptoms of schizophrenia after 60, but some research has suggested it is as high as 4 percent of people with the disease.
People who fall in these categories tend to be more likely to be female and have less educational, occupational, and social history deficits than other people with schizophrenia. Relatives of people with late-onset schizophrenia are less likely to have the disease themselves than patients with early-onset schizophrenia. People who begin showing symptoms after age 40 are less likely to have disorganized thoughts and blunting of emotions. They are more likely to have hallucinations of the senses of sight, taste, and smell, and are more likely to have persecutory delusions in which they feel someone or something is out to get them. In addition to these symptoms, people with late - onset psychosis are more likely to have auditory hallucinations of a particular kind, those in which they hear a running commentary of their minute-to-minute actions. These voices tend to be abused and denigrating. Patients who begin having symptoms over the age of 60 are even less likely to have disorganized thoughts and are less likely to have the negative symptoms of schizophrenia. It has also been suggested that those patients who start having symptoms over age 60 more likely to have sensory deficits, particularly deafness.
Close to 60 percent of people with late or very late onset schizophrenia show almost complete resolution of psychotic symptoms with treatment with antipsychotic medications. Patients tend to show improvement with social skills training and cognitive behavioral therapy as well. A future blog will talk about specific medications and other treatments of schizophrenia. As the baby-boomer generation ages, late-onset schizophrenia will be more and more of a concern for public health and families in general.
Paul Ballas, D.O., wrote about mental health for HealthCentral. He is a member of the American Psychiatric Association and has been a presenter at the American Psychiatric Association and American Academy of Psychosomatic Medicine meetings.