Abstract
Objectives: The aim of this study was to characterize the symptoms at onset/past and current symptoms of patients with Very Late-Onset Schizophrenia-Like Psychosis (VLOSLP; first onset of psychotic symptoms at/or after 60 years old) with those of elderly patients diagnosed with schizophrenia before the age of 40 years old (Early-Onset Schizophrenia—EOS) in order to validate the clinical nosology proposed by the International Late-Onset Schizophrenia Group. Methods: This is a between-patient comparison study with retrospective and current data taken from an historical cohort that was conducted from May/2005 to August/2008. Seventeen VLOSLP and 17 EOS were included. Schizophrenia and schizophrenia-like psychotic disorders were initially diagnosed by board-certified psychiatrists with the Diagnostic and Statistical Manual Criteria at use at onset of the disorders. Patients’ symptoms were assessed with the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS). The general scores on the SAPS/SANS were the primary outcomes. Results: Both groups had hallucinations and delusions at onset of the disease, but the following symptoms were more present and severe in EOS than in VLOSLP: hallucinations (p = 0.001); assiduity loss (p p = 0.001), reference (p p = 0.001) delusions. VLOSLP had mostly persecutory delusions. At current evaluation (follow-up of cohort), most patients in the two groups presented residual symptoms of anhedonia and apathy, but EOS, presented more symptoms of friendship poverty (d = 1.42, large effect size) than VLOSLP. The neuroimaging studies (when available) at follow-up demonstrated greater vascular cerebral lesions/vulnerability in VLOSLP than in EOS patients. Conclusion: This study showed that both VLOSLP and EOS had positive and negative symptoms in the past/at onset of the disease, but they were more severe in EOS than in VLOSLP. However, the positive symptoms of both groups at follow-up of the cohort (current evaluation) responded relatively well to neuroleptics.
Highlights
A recent study found that the one-year prevalence of all schizophrenia spectrum disorders in individuals aged 60 years and older was 0.71% [1]
The aim of this study was to characterize the symptoms at onset/past and current symptoms of patients with Very Late-Onset Schizophrenia-Like Psychosis (VLOSLP; first onset of psychotic symptoms at/or after 60 years old) with those of elderly patients diagnosed with schizophrenia before the age of 40 years old (Early-Onset Schizophrenia—EOS) in order to validate the clinical nosology proposed by the International Late-Onset Schizophrenia Group
A visual inspection of Table 1 reveals that both groups included more women than men, that EOS had longer disease duration than VLOSLP, and that more VLOSLP were married/widowed than EOS
Summary
A recent study found that the one-year prevalence of all schizophrenia spectrum disorders in individuals aged 60 years and older was 0.71% [1]. The International Late-Onset Schizophrenia Group proposed that early-onset schizophrenia or EOS (onset before the age of 40) and LOS (onset after 40 years old) would be more similar than different in terms of symptoms [5,6] whereas VLOSLP (onset after 60 years old) would present with a lower prevalence of formal thought disorder and affective blunting, and a higher prevalence of visual hallucinations than EOS [5].
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