Late Onset Schizophrenia

Historically, the prevalence of schizophrenia has shown that most patients develop symptoms in their late teens or early adulthood. These cases usually precede a family history of the disorder and the etiology of schizophrenia is strongly linked to genetics. However, some individuals develop schizophrenia during their middle age or even late into their 60s and this is known clinically as late onset schizophrenia. In the following descriptions, late onset schizophrenia will be discussed mainly in terms of its comparison to early onset schizophrenia.

Symptoms of Late Onset Schizophrenia

Patients suffering from late onset schizophrenia suffer from many of the same symptoms as patients diagnosed with early onset schizophrenia. Late onset schizophrenics very rarely suffer from negative symptoms such as affective flattening, blunting, or depression-like symptoms. However, more agressive positive symptoms, extending to olfactory and tactile hallucinations as well as  auditory and visual hallucinations and delusions are quite common. Individuals who start to experience symptoms of schizophrenia after their 40s are likely to experience some of the following symptoms:

Partition Delusions: This type of delusion is dominated by a fear of being contaminated, captured, or spied upon. The patient believes that radiation, chemicals, disease, people, or spiritual entities can pass through walls or other physical barriers.

Persecutory Delusions: This type of delusion is dominated by the chronic fear of being persecuted. The patient believes that he/she is followed, intercepted, and constantly hunted down by some entity wishing to harm them, usually in a fatal way.

Running Narrative Hallucinations: This type of hallucination revolves around hearing a chronic, running narrative in response to the host’s every actions. Some patients find this symptom particularly invasive and intolerable.

Third-Person Hallucinations: In this type of hallucination, the patient hears voices talking about him/her in third person. This type of hallucination is perceived as stressful as the voices usually speak ill or accusingly of the patient.

Accusatory Hallucinations: This type of auditory hallucination involves the patient hearing voices that accuse him/her of being immoral in some manner or another or of being ‘bad’, ‘sinful’, or pushing him/her to compensate for some behavior.

Patients diagnosed with late onset schizophrenia are more likely to suffer from paranoid type delusions, but are less likely to experience negative symptoms. The prognosis for patients diagnosed with late onset schizophrenia is also much more favorable than that of their early diagnosed peers. Women are more likely to be diagnosed with late onset schizophrenia and sometimes, in cases of very late onset, the disorder is linked to dementia.

Etiology of Late Onset Schizophrenia

The cause of late onset schizophrenia is even more perplexing than its counterpart. Theories about the etiology of late onset schizophrenia include age-related neurological deterioration and environmentally triggered onset. In high risk patients (those with a family history of schizophrenia), individuals are usually monitored for early signs of the disorder, however in the case of late-onset schizophrenia, it is assumed that the high risk period is passed and the late onset is attributed to stimulus from an environmental stressor that is triggering a predisposition for the disorder. Interesting to note is that patients diagnosed with schizophrenia past their 40s show significantly more neurostructural damage than their early-diagnosed peers. For example ventricle enlargement and loss of gray matter volume is significantly increased. Etiologically, this validates the theory of environmental influence and the need of an environmental stressor to trigger the onset of the disorder.

Many researchers believe that individuals diagnosed with late onset schizophrenia are pre-disposed for the condition and do not express any symptoms until later in life when environmental stressors such as retirement, the loss of children to adulthood, the death of parents or peers, or mid-life crises strike. An interesting thing to note from this trend is the onset of schizophrenia (early and late) during transitional periods in an individual’s life.  It gives a clue to the broad etiology of schizophrenia in general.

Late Onset Schizophrenia and Dementia

Many researchers have wondered whether late onset of schizophrenia is somehow related to dementia. Brain studies have suggested that although tempting, this theory is not strong enough given that proof of brain degenerative causes for late onset of schizophrenia have not yet been confirmed.

Certain psychotic symptoms are the main symptoms of both dementia and schizophrenia and this is the primary reason these two are linked. Etiologically, the disorders are different and only related to each other symptomatically.

Treatment of Late Onset Schizophrenia

Antipsychotic medications have proven to be very effective in treating the late-onset of schizophrenia. This type of the disorder also has the best prognosis and symptoms are almost exclusively due to neurostructural causes rather than neurotransmitter function. Therefore, antipsychotic medications can properly treat positive symptoms.

A downside of late onset schizophrenia is that cognitive treatment is much less successful and often, if cognitive damage is severe, patients are not likely to recuperate completely or re-learn certain cognitive functions.

The late onset of schizophrenia can also be challenging to treat given the fact that as a disease of age-related reasons (especially the type diagnosed after the age of sixty five), it is likely to be the cause of multiple reasons completely unrelated to schizophrenia under normal conditions. Patients of elderly age may have psychotic symptoms, but these can be related to general cognitive dysfunction brought about by aging.

Also, since late onset schizophrenia is devoid of any negative symptoms it is unlikely that the disorder will be misdiagnosed and thus mistreated with antidepressants.