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late-onset schizophrenia

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 a) attention deficit b) 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

General

schizophrenia

References

  1. 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
  2. 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: 10671383
  3. 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: 20199491 Free PMC Article
  4. 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. 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. 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: 30904777 https://www.sciencedirect.com/science/article/abs/pii/S0165032718318470