Very-Late-Onset Schizophrenia-Like Psychosis.
(The information presented below is abstracted from an article appearing in American Journal of Psychiatry, 2000; 157(2): 172-178. All quotes are from this article.)
In July of 1998, a group of 17 individuals from all over the world met to develop a consensus report on late-onset schizophrenia. The participants included representatives from the basic sciences, clinical schizophrenia research centers as well as academic and clinical geriatric psychiatry centers. Included in this group were Dr. Nancy Andreasen of the University of Iowa Hospitals and Clinics, Dr. Dilip V. Jeste of University of California at San Diego/San Diego VA Medical Center and Drs. Godfrey Pearlson & Peter Rabins of Johns Hopkins Hospital. Seventeen individuals formed the group called The International Late-Onset Schizophrenia Group.
The aim of this conference was to review the research literature on late-onset schizophrenia and the current status of this diagnosis in the various countries represented at this meeting. The "Group" looked at late-onset schizophrenia, using 40 years of age as a criterion for late-onset schizophrenia, and after 60 years of age as the criteria for very-late-onset schizophrenia-like psychosis. They felt that "Schizophrenia-like psychosis, which cannot be attributed either to an affective disorder or focal or progressive structural brain abnormalities, can arise at any time in the life cycle between childhood and old age." Epidemiological evidence pointed to the use of 60 years as a cutoff to define the very-late-onset cases of schizophrenia-like psychosis.
In exploring very-late-onset cases, these researchers concluded that the "cases may arise in the context of sensory impairment and social isolation." There was very little indication of formal thought disorder (a benchmark in classical schizophrenia) and negative symptoms in the very-late onset cases when compared to earlier-onset schizophrenia.
The group could find no evidence that a progressive dementing disorder is associated with onset of very-late-onset cases. Mild cognitive deficits in the areas of learning and abstraction/cognitive flexibility were found. Family history of schizophrenia did not prove a risk factor.
Assessment and Treatment recommendations were as follows:
The International Late-Onset Schizophrenia Group indicated that "schizophrenia continues to be an illness of mysterious causation that usually strikes in adolescence or early adulthood but may uncommonly affect children or express itself for the first time in middle or later life. Both developmental and degenerative processes that affect specific brain circuitry have been implicated. Intensive study of late- and very-late-onset cases may ultimately shed light on etiology."
Data suggests late-onset patients complain more of visual, tactile and olfactory hallucinations, persecutory delusions and third person running commentary and accusatory or abusive auditory hallucinations. Affective flattening or blunting is not commonly present.
The incidence of this illness in the general population over 65 years of age ranges from 0.1% to 0.5 %, with an increase of schizophrenia-like psychosis of 11% every five years over 65. Women appear to be over-represented in late-onset schizophrenia.
Physicians and psychiatrists need to be more aware of this illness and not always attribute atypical behavior in the elderly to dementia.
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Harold Rubin, MS, ABD, CRC, Guest Lecturer
February 10, 2000
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