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Late onset schizophrenia-like illness.

T J Craig1, Z Bregman

  • 1Department of Psychiatry and Behavioral Science, SUNY Stony Brook.

Journal of the American Geriatrics Society
|February 1, 1988
PubMed
Summary
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Late-onset schizophrenia, defined as symptom onset after age 45, presents diverse clinical courses and underlying pathologies, not just unequivocal schizophrenia. Many patients show affective symptoms or organic deterioration, impacting treatment response.

Area of Science:

  • Geriatric Psychiatry
  • Neuroscience
  • Clinical Psychology

Background:

  • Late-onset schizophrenia (LOS) is clinically distinct from early-onset schizophrenia.
  • Understanding the diverse presentations and outcomes of LOS is crucial for accurate diagnosis and effective treatment.

Purpose of the Study:

  • To investigate the clinical characteristics, treatment response, and diagnostic considerations of schizophrenia with onset after age 45 in a geriatric psychiatric inpatient population.

Main Methods:

  • Retrospective chart review of 658 geriatric psychiatric inpatients (≥65 years).
  • Identification of 32 patients meeting DSM-III criteria for schizophrenia, excluding the age of onset criterion.
  • Analysis of clinical course, symptomatology, and treatment response.

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Main Results:

  • 4.8% of patients had schizophrenia onset after age 45.
  • Only 25% exhibited a clear schizophrenic pattern; others showed significant affective symptoms (20%), brief psychotic episodes with remission (15.6%), or organic deterioration (40.6%).
  • Depressive symptoms and assaultive behavior predicted good treatment response, while sensory deficits and organicity predicted poor response.

Conclusions:

  • Late-onset schizophreniform illness may represent diverse underlying pathologies.
  • The clinical presentation and treatment response in LOS are highly variable, necessitating a broad differential diagnosis.
  • Identifying specific clinical predictors can guide treatment strategies for patients with late-onset psychosis.