- Schizophrenia is characterized by positive symptoms (eg, hallucinations, delusions, and thought disorder) and negative symptoms (eg, social dilapidation and apathy).
- Approximately 85% of older adults with schizophrenia experienced onset of illness in early adult life. However, 10%–15% of cases of schizophrenia first come to clinical attention after age 45.
- Schizophrenia with onset between ages 40 to 60 is called “late-onset schizophrenia.” Onset after age 60 is considered “very-late-onset schizophrenia-like psychosis.”
- Late-onset schizophrenia-like conditions are characterized by prominent persecutory (paranoid) delusions and multimodal hallucinations manifesting as complaints, eg, items are being stolen or a neighbor is persistently banging on the walls or roof.
- A schizophrenia-like psychosis can be diagnosed only when cognitive disorder, mood disorder, or other explanatory medical conditions such as delirium or focal brain pathology have been excluded.
- The schizophrenia-like psychoses of late life differ from schizophrenia beginning in early life in three ways:
- Thought disorder (eg, speech in which a series of thoughts are not connected to one another in a logical fashion) is much less common in older adults. When illogical speech occurs in late life, delirium or dementia should be excluded.
- Social deterioration and dilapidation is rare among older adults; personality is often intact in late-onset cases.
- Late-onset schizophrenia is more common among women than men.
- Many individuals with schizophrenia experience fewer hallucinations and delusions as they age, others remain significantly functionally impaired by psychotic symptoms or may experience further deterioration.
- Cognitively, older individuals with schizophrenia experience similar age-associated declines as those without schizophrenia. A subgroup of individuals with schizophrenia may experience accelerated decline, particularly if they have been chronically institutionalized.
- Older adults with schizophrenia have an increased risk of suicidal behavior compared with that of their peers without mental illness.