Late Age of Onset Schizophrenia: Present but unaccounted for

Abstract

Late Age of Onset Schizophrenia (symptom onset after age 45) occurs far more often than is recognized. Age factors should not prevent correct diagnosis and treatment. Additionally, its recognition markedly increases (at least 5- to 10-fold) the calculated risk factors for first degree relatives. Schizophrenia must be carefully differentiated from a Delusional Disorder. Delusional Disorder is characterized strictly by delusions, without hallucinations or fragmentation of thought, and will not benefit from antipsychotics. The failure of the Late Paraphrenia diagnostic classification system to differentiate the two compromises its utility. Chemotherapeutic trials can be very helpful in diagnostic clarification as well as in treatment. Late Age of Onset schizophrenics will tend to be female; will usually have married; will often have a positive family history for Schizophrenia; other affected relatives may have a tendency for symptom expression at later ages as well; and will generally have a gratifying response to antipsychotic trials. They will usually respond (or not respond) to a specific antipsychotic in a similar manner to other affected relatives. Organic, affective, and schizophrenic syndromes may have many overlapping clinical symptoms on initial ( cross-sectional) presentation which are non-specific in delineating the etiology of the psychosis. Thorough organic work-up, including EEG; a longitudinal history of the patient; a family psychiatric pedigree; plus highly specific clinical trials of antipsychotics, antidepressants, lithium, or anticonvulsants may all contribute to diagnostic clarification and ultimately leave few cases of psychosis in the elderly population unresolved.