Abstract
The authors present psychopathological, cognitive, and functional assessments of 43 middle-aged and elderly patients with schizophrenia who have been hospitalized in long-term facilities. These patients were compared to a matched outpatient sample (n=43) from the San Diego VAMC. Inpatients were age>45 and had been hospitalized at least 6 months within the past year in the Chillicothe VAMC inpatient units. Patients also met DSM-IV criteria for schizophrenia or schizoaffective disorder. Assessments were performed using the following instruments: Ham-D, PANSS, MMSE, and Quality of Well Being (QWB) Scale. Scores were compared to outpatients matched on the basis of age and education using t-tests. The mean (x) age of onset of the inpatients was significantly lower than the outpatients (x ± SD=24.5 ± 6.1 vs. 30.4 ± 11.4; P=0.003). The total PANSS scores of the inpatients were significantly higher than the outpatient scores (98.7 ± 26.7 vs. 64.7 ± 16.0; P<0.0001). The positive, negative, and general psychopathology subscales of the PANSS were significantly higher in the inpatients. The MMSE and QWB scores of the inpatient sample were also significantly different from that of the outpatients. For instance, QWB scores in the inpatients were 0.52 ± 0.08 vs. 0.57 ± 0.12 in the outpatients (P=0.01). In addition, MMSE scores in the inpatients were 21.9 ± 7.0 vs. 26.4 ± 3.2 in the outpatients (P=0.0003). There was no significant difference between the Ham-D scores in the two groups. These studies support the hypothesis that the earlier age of onset in inpatients leads to greater disability in later life. In addition, the findings support the premise that chronically hospitalized inpatients exhibit higher levels of psychopathology, greater cognitive impairment, and lower quality of life indices. Obtaining a better understanding of this subset of older individuals with schizophrenia may help investigators better determine which interventions would optimize their treatment. Additional studies are needed to better understand this population of patients. P32
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