Clinical profile and functioning in late-onset versus early-onset schizophrenia: a comparative study

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Abstract

Background

Psychotic symptoms arising de novo among older adults are not uncommon. Their distinctive features and phenomenology are of increasing clinical interest. Their comparison with early-onset psychosis can provide better insight into this complex phenomenon.

Aim

The aim of this study was to compare the clinical picture and functioning of 50 patients presenting with late-onset schizophrenia (LOS) (>50 years) with a similar number of patients with early onset (<50 years).

Patients and methods

The recruited patients were interviewed using the Structured Clinical Interview for DSM Axis-I Disorders (SCID-I). Those fulfilling the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. diagnostic criteria for schizophrenia and other psychotic disorders underwent further clinical evaluation of the psychopathology using the Positive and Negative Syndrome Scale. The functioning was estimated using activities of daily living and instrumental activities of daily living.

Results

Patients with LOS were mainly women, unmarried or divorced, living alone, had less familial psychiatric history, higher education and better premorbid functioning compared with their earlier-onset counterparts. Their psychotic symptoms occurred mainly in conjunction with a number of chronic medical illnesses and sensory deficits, with less impairment in daily living function in contrast to the earlier-onset group. Clinically, the delayed development of psychosis was associated with a relative lack of negative symptoms, affective blunting, formal thought disorder and the absence of conceptual disorganization. Nonetheless, it was associated with prominent systematized delusion and multimodal hallucinations. Our study showed that paranoid schizophrenia was by far the most frequent diagnostic type of schizophrenia encountered in the LOS group, whereas the disorganized and undifferentiated schizophrenia subtypes were the most common diagnoses in the early-onset schizophrenia group.

Conclusion

Our data support the finding of differences in the phenomenology, psychosocial variables and functioning between patients with LOS and early-onset schizophrenia. Hence, a critical re-evaluation of the current diagnostic systems in the light of this awareness is very important. Schizophrenia symptoms arising de novo at an older age is better designated in the classification as a subtype of schizophrenia. This remains a nosological caveat that requires further evaluations.

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