Late-onset Schizophrenia Research Articles

Cognitive functions in late-onset psychosis

The review discusses cognitive functions in late-onset schizophrenia and very late-onset schizophrenia-like psychosis compared to cognition in normal aging, early-onset schizophrenia, and neurodegenerative diseases. The problem of the dynamics of the state of the cognitive functions in patients with late-onset schizophrenic psychoses is highlighted, and prospects for further research are discussed. Patients with late-onset schizophrenic psychosis are characterized by more pronounced cognitive deficits compared to normal aging, but less severe than cognitive changes observed in early-onset schizophrenia. Late-onset schizophrenia may be a heterogeneous condition in terms of cognitive dysfunction.

The use of antioxidant medicine as an adjunctive therapy in late-onset schizophrenia spectrum disorders

BACKGROUND. Imbalance in the activity of neurotransmitter systems, mitochondrial impairment, and oxidative stress are potential neurobiological factors in the schizophrenia development.
 AIM. To test the hypothesis about the possibility of a subgroup selection from patients with late-onset schizophrenia spectrum disorders, for which the use of ethylmethylhydroxypyridine succinate as an adjunctive to antipsychotic therapy would be the most effective in relation to symptoms that are relatively more pronounced in patients of this subgroup.
 MATERIAL AND METHODS. 43 patients (women and men) aged 4578 years with late-onset (after 40 years) schizophrenia spectrum disorders were examined using clinical psychopathological, psychometric, biochemical and statistical research methods. Enzymatic activities of cytochrome C-oxidase, glutamate dehydrogenase, glutathione reductase and glutathione-S-transferase were assessed in blood cells twice (on a patient admission to the hospital and after a 28-day treatment course).
 RESULTS. Criteria for a patient assignment to the subgroup for ethylmethylhydroxypyridine succinate prescription were: more prominent side effects of pharmacotherapy, predominance of anxiety-hypochondriac symptoms and a lesser severity of psychosis. Before the treatment starting, the subgroup to which ethylmethylhydroxypyridine succinate was prescribed significantly differed in the activity of platelet glutamate dehydrogenase (p=0.031), glutathione-S-transferase (p=0.005), and erythrocyte glutathione reductase (p=0.045). As a result of the treatment course, the severity of symptoms by which the patients receiving ethylmethylhydroxypyridine succinate significantly differed before the starting the treatment, became undistinguished from those in the rest examined patients. After the treatment course, no significant differences in enzymatic activities were found in patients treated with ethylmethylhydroxypyridine succinate from those in other patients.
 CONCLUSION. This study confirmed the clinical validity of using a medicine with antioxidant properties as an adjunctive therapy to the main treatment in the selected subgroup of patients.

The challenges of the family caregivers in caring of late onset schizophrenia and very late onset schizophrenia‐like psychosis: Caregiver risk of burden and neurodegenerative disease

AbstractBackgroundThe challenges of taking care family member with Late Onset Schizophrenia (LOS) and Very Late Onset Schizophrenia Like Psychosis (VLOSLP) were enormous, include physiological and phycological factors. Family caregiver who taking care patients with schizophrenia experience emotional, physical, and financial challenges and lead of the caring process include decision of the patient’s institutionalizations. This study to investigate the burden experienced by family caregiver taking care to their family member with Late Onset Schizophrenia (LOS) and Very Late Onset Schizophrenia Like Psychosis (VLOSLP). Moreover, the impact of their challenges of the caring were maintain the FCG emotional wellbeing and how they cope of family caregivers’ strategies for the challenges.MethodThis study was cross ‐sectional, descriptive and correlational study. a total of 172 of Dyad FCG were recruited. the research instrument included the Revised Memory Behavior Checklist (RMBC), The Zarid Burden Interview (ZBI), and the Brief Psychiatric Rating Scale (BPRS). Descriptive study, Independent sample t‐test correlation and one‐way ANOVA were use to examined.ResultThe results indicated of more than 76% FCG were burdened and 29% exhibited Dementia. There was positive correlation of FCG Burden with patients Onset (Beta =1.27, p =<.01), FCG sex, Income (Beta =1.31, p =<.01), and level education (Beta =1.28, p =<.01). There was statistically positive correlation of FCG high burden with the level cognitive of FCG (Beta =1.32, p =<.01).ConclusionThe findings improve our understanding about burden and emotional wellbeing in taking care of major schizophrenic with Late Onset Schizophrenia (LOS) and Very Late Onset Schizophrenia Like Psychosis (VLOSLP) especially for women might need a management for their cope with their own feelings. The findings of the study might benefit for health professional to plan the strategies focusing on help challenges of the family caregivers especially for women. the lesson learner from the FCG of LOS might be used to improve the caregiving strategies on patients with VLOSLP.

Late‐onset schizophrenia and the competing risks of dementia and death: A national cohort study

AbstractBackgroundKnowledge is limited regarding the association between very‐late onset schizophrenia and the risks of risks of death and dementia. We aimed examine the associations between very‐late onset schizophrenia and the risks of death and dementia.MethodA prospective Israeli cohort study (N=94,120) of persons without either dementia or schizophrenia (2002 to 2012), aged 60 to 90 in 2012, were followed‐up for dementia or death (2013 to 2017). During follow‐up schizophrenia was classified as present from the age of the first ICD‐9 schizophrenia diagnosis, otherwise as absent. The association between schizophrenia and the competing risk of death and dementia was quantified with Hazard Ratios (HR) and their 95% confidence intervals (CI), fitting six competing risk analyses, unadjusted (Unadj.) and adjusted (Adj.) with increasing complexity. We tested the robustness of the results in nine sensitivity analyses.ResultThe group with schizophrenia had higher rates of death (n=61, 18.5% vs. n=7,028, 7.5%, respectively) and dementia (n=64, 19.5% vs. n=5,962, 6.4%, respectively). In the primary analysis, the group with compared to the group without schizophrenia had higher risks of death (Unadj. HR= 3.10, 95% CI = 2.36, 4.06, P <.001; Adj. HR= 2.89, 95% CI = 2.15, 3.89; P<.001) and dementia (Unadj. HR = 3.81, 95% CI = 2.90, 4.99, P <.001; Adj. HR= 2.67, 95% CI = 1.82, 3.91; P<.001). The results remained significant (P <.05) in all sensitivity analyses, including among persons without antipsychotic exposure.ConclusionVery‐late onset schizophrenia was associated with increased death and dementia risks, possibly due to accelerated aging.

Hepatitis C-associated late-onset schizophrenia: a nationwide, population-based cohort study.

Background:Whether infection with the hepatitis C virus (HCV) causes schizophrenia — and whether the associated risk reverses after anti-HCV therapy — is unknown; we aimed to investigate these topics.Methods:We conducted a nationwide, population-based cohort study using the Taiwan National Health Insurance Research Database (TNHIRD). A diagnosis of schizophrenia was based on criteria from the International Classification of Diseases, 9th revision (295.xx).Results:From 2003 to 2012, from a total population of 19 298 735, we enrolled 3 propensity-score-matched cohorts (1:2:2): HCV-treated (8931 HCV-infected patients who had received interferon-based therapy for ≥ 6 months); HCV-untreated (17 862); and HCV-uninfected (17 862) from the TNHIRD. Of the total sample (44 655), 82.81% (36 980) were 40 years of age or older. Of the 3 cohorts, the HCV-untreated group had the highest 9-year cumulative incidence of schizophrenia (0.870%, 95% confidence interval [CI] 0.556%–1.311%; p < 0.001); the HCV-treated (0.251%, 95% CI 0.091%–0.599%) and HCV-uninfected (0.118%, 95% CI 0.062%–0.213%) cohorts showed similar cumulative incidence of schizophrenia (p = 0.33). Multivariate Cox analyses showed that HCV positivity (hazard ratio [HR] 3.469, 95% CI 2.168–5.551) was independently associated with the development of schizophrenia. The HCV-untreated cohort also had the highest cumulative incidence of overall mortality (20.799%, 95% CI 18.739%–22.936%; p < 0.001); the HCV-treated (12.518%, 95% CI 8.707%–17.052%) and HCV uninfected (6.707%, 95% CI 5.533%–8.026%) cohorts showed similar cumulative incidence of mortality (p = 0.12).Limitations:We were unable to determine the precise mechanism of the increased risk of schizophrenia in patients with HCV infection.Conclusion:In a population-based cohort (most aged ≥ 40 years), HCV positivity was a potential risk factor for the development of schizophrenia; the HCV-associated risk of schizophrenia might be reversed by interferon-based antiviral therapy.

A nationwide nested case-control study of new-onset obsessive-compulsive disorder following antipsychotics use in schizophrenia.

A substantial proportion of patients with schizophrenia suffer from comorbid obsessive-compulsive disorder (OCD) possibly associated with antipsychotics. However, little is known about the comparative risks of the antipsychotics. The present study aimed to investigate the risk of new-onset OCD following the initiation of different antipsychotic medications for schizophrenia relative to haloperidol. Using the Korean national claims data, patients aged 15-60years newly diagnosed with schizophrenia between 2010 and 2018 were identified. Of the 47,808 patients with schizophrenia treated with nine commonly prescribed antipsychotics, 775 new-onset OCD patients were matched to 3,100 patients without OCD using nested case-control design with 1:4 case-control matching based on the sex, age of index date, date of schizophrenia diagnosis, observation period, locations of medical institutions, and level of medical facilities. Using multivariable conditional logistic regression analysis, odd ratios (ORs) for new-onset OCD comparing each antipsychotic agent relative to haloperidol were computed. The risk for new-onset OCD during treatment with clozapine was significantly higher than that with haloperidol (adjusted OR 2.86; 95% confidence interval [1.63-5.03]). The risks for new-onset OCD with other antipsychotics were not significantly different from that with haloperidol.In subgroup analysis, the early and intermediate, but not late-onset schizophrenia group showed significant risk for OCD associated with clozapine use. The present findings, based on real-world national representative data, provide reliable evidence for the risk of new-onset OCD in patients with schizophrenia receiving clozapine at a population level.

Predictors of the duration of professional activity in patients with schizophrenia

Introduction. Schizophrenia is a complex mental disorder that significantly impacts individuals’ ability to engage in productive professional activities. Understanding the factors that contribute to the duration of professional activity in patients with schizophrenia can aid in developing effective interventions and support systems in order to improve quality of patients life, inform clinical practice, and reduce economic burden. Materials and methods. The study has a cross-sectional design, and had the main purpose of identifying the key predictors of employment duration among a sample of 202 individuals with schizophrenia. Participants were divided into four subcategories based on their work experience: never worked, worked 1 to 5 years, worked 5 to 10 years, and worked more than 10 years. This study employs multinominal logistic regression to compare employment (formulated as categorical variables) and ANOVA with post hoc Bonferroni correction (formulated as continue variables), to investigate predictors of employment duration in patients with schizophrenia. Statistical significance was considered at p≤.05. Several key predictors were identified, including socio-demographic factors like relationship status and clinical characteristics such as hospitalization frequency. Results. Our results indicate that being in a stable relationship could potentially serve as a positive predictor for longer employment duration. Gender differences were noted, with women generally having longer periods of employment, possibly influenced by a later onset of schizophrenia in this gender group. Contrary to expectations, medication type did not significantly impact employment duration. Moreover, the relationship between employment and hospitalization appeared complex and not directly proportional. Conclusion. The study highlights that unemployment in this population is a modifiable state and not an inherent trait. These findings have significant implications for tailoring interventions and providing personalized support to optimize professional activity outcomes for individuals with schizophrenia.

Performance on verbal fluency in late-onset schizophrenia is more preserved than in early-onset schizophrenia

IntroductionAccording to the literature, cognition may be more preserved in late-onset schizophrenia (LOS) compared to early-onset schizophrenia (EOS), but data are limited.ObjectivesTo compare performance on cognitive tests in LOS and EOS.MethodsLOS patients (n=14, mean age 58.1±8.2, 13 females, illness duration 1.07±1.5 years) and age-comparable controls (n=17, mean age 55.3±7.8, 12 females), EOS patients (n=25, mean age 20.7±3.9, 25 males, illness duration 0.75±0.62 years) and age-comparable controls (n=15, mean age 22.9±2.3, 15 males) underwent the Brief Assessment of Cognition in Schizophrenia (BACS) comprised of six subtests: Verbal Memory, Digit Sequencing, Verbal Fluency, Token Motor Task, Symbol Coding, and Tower of London. The Mann-Whitney U test with Bonferroni correction for multiple comparisons was applied (p &lt;.05/8, i.e. p &lt;.006).ResultsCompared to LOS, EOS patients had lower score on Verbal Fluency (VF): U=78, p=.004; mean T-scores are 43.5±9.5 and 33.6±12.6 for LOS and EOS, respectively. Additionally, we compared VF performance in each clinical group with age-comparable controls and revealed significantly lower performance in both LOS (U=37.5, p=.001) and EOS (U=56.5, p=.000).ConclusionsPerformance on VF is deteriorated in clinical groups, but may be more intact in LOS compared to EOS. This result is of particular interest because low performance on VF is considered as a cognitive endophenotype of schizophrenia. Performance on VF requires preserved executive functions, language, and processing speed. Our results are in line with the idea that LOS and EOS may be different subtypes of schizophrenia. Limitation of this study is that the clinical groups are not sex-matched.

CT abnormalities in late-onset schizophrenia and schizoaffective disorder correlate with number of psychotic episodes and cognitive dysfunction

IntroductionLate-onset psychosis is associated with development of dementia. Search for neuroimaging signs in these patients is important.ObjectivesThis study aimed to assess CT abnormalities and their clinical correlations in late-onset psychosis.MethodsPatients with DSM-V diagnosis of late-onset schizophrenia (LOS, n= 43, age 65.2±9.4, 90% females) and schizoaffective disorder (LOSAP, n=9, age 64.9±5.8, 30% females) underwent CT and cognitive examination before discharge. Atrophy and ventricles enlargement were ranged from 0 (abs.) to 3 (sev.); vascular pathology - from 0 (abs.) to 2 (mult.). Patients were compared with 16 controls (age 58.1±10.8, 50% females). Nonparametric statistic was used.ResultsPatients had more severe frontal (χ2 19.7, р=0.003), temporal (χ2 10.7, р=0.097), parietal (χ2 21.7, р=0.001), cerebellar (χ2 14.8, р=0.005) atrophy and ventricles enlargement (χ2 15.6 р=0.016). 29 % of LOS and 44% of LOSAP patients had leukoaraiosis. All findings correlated with age. In patients ventricular enlargement correlated with number of psychotic episodes (r=0.338, р=0.014), lower MMSE (r=-0.314, p=0.045), immediate (r=-0.508, р=0.002) and delayed (r=-0.404, р=0.016) verbal recall. Temporal atrophy correlated with number of episodes (r=0.439, р=0.001), lower MMSE (r=-0.327, p=0.037) and immediate verbal recall (r=-0.339, p=0.046); cerebellum atrophy - with lower MMSE (r=-0.338, р=0.036) and FAB (r=-0.407, р=0.01); leukoaraiosis - with number of episodes (r=0.503, р=0.001), prolonged hospital stay (r=0.345, p=0.024); vascular pathology – with number of episodes (r=0.336, р=0.015), lower visual recall (r=-0.399, р=0.019), performance time in TMT-B (r=0.404, р=0.024).ConclusionsCorrelations between CT pathology, cognitive dysfunction and number of psychotic episodes may reflect progression of brain pathology due to psychosis.DisclosureNo significant relationships.

Neurosyphilis With Psychosis as the Primary Presentation

Patients with neurosyphilis, which is now a rare disease because of the availability of antibiotics, can initially present with psychiatric symptoms instead of the more well-known physical findings, such as general paresis, tabes dorsalis, and Argyll Robertson pupils. A subset of patients with primarily psychiatric symptoms beginning later in life tend to be incorrectly diagnosed as having late-onset schizophrenia. This case report describes a 67-year-old female with psychiatric symptoms starting 8 years prior to presentation who was misdiagnosed with late-onset schizophrenia. Because her symptoms first appeared at the later age of 59, additional testing was performed to rule out a medical etiology. The patient was found to be positive for syphilis infection in the serum and cerebrospinal fluid. She displayed no other notable symptoms of syphilis aside from bizarre behaviors and paranoid delusions. This case demonstrates the importance of considering organic infectious diseases, such as syphilis, when psychosis initially presents at an older age.

Late-onset and nonlate-onset schizophrenia: A comparison of clinical characteristics in a multicenter study.

Data are scarce regarding the potential clinical differences between non-late onset schizophrenia (NLOS, i.e., disorder occurring before 40 years of age), late-onset schizophrenia (LOS, occurring between ages 40 and 60 years) and very-late-onset schizophrenia-like psychosis (VLOSLP, occurring after 60 years of age). Furthermore, previous research compared LOS patients with non-age matched NLOS patients. In this study, we sought to examine potential clinical differences between patients of similar age with LOS and NLOS. This is a cross-sectional multicentre study that recruited in- and outpatients older adults (aged ≥55 years) with an ICD-10 diagnosis of schizophrenia or schizoaffective disorder with NLOS and LOS. Sociodemographic and clinical characteristics, comorbidity, psychotropic medications, quality of life, functioning, and mental health care utilization were drawn for comparison. Two hundred seventy-two participants (79.8%) had NLOS, 61 (17.9%) LOS, and 8 (2.3%) VLOSLP. LOS was significantly and independently associated with greater severity of emotional withdrawal and lower severity of depression (all p<0.05). However, the magnitude of these associations was modest, with significant adjusted odds ratios ranging from 0.71 to 1.24, and there were no significant between-group differences in other characteristics. In an age-matched multicenter sample of elderly patients with schizophrenia, older adults with LOS were largely similar to older adults with NLOS in terms of clinical characteristics. The few differences observed may be at least partially related to symptom fluctuation with time. Implications of these findings for pharmacological and nonpharmacological management is yet to be determined.

Association of Antihypertensive Drug Target Genes With Psychiatric Disorders

Observational studies have reported associations between antihypertensive medication and psychiatric disorders, although the reported direction of association appears to be dependent on drug class. To estimate the potential effect of different antihypertensive drug classes on schizophrenia, bipolar disorder, and major depressive disorder. This 2-sample mendelian randomization study assessed the association between a single-nucleotide variant (SNV) and drug target gene expression derived from existing expression quantitative trait loci (eQTL) data in blood (sample 1) and the SNV-disease association from published case-control genome-wide association studies (sample 2). Significant associations were corroborated using published brain eQTL and protein QTL data. Participants included 40 675 patients with schizophrenia and 64 643 controls, 20 352 patients with bipolar disorder and 31 358 controls, and 135 458 patients with major depressive disorder and 344 901 controls. Blood eQTL levels were measured in 31 684 individuals from 37 cohorts (eQTLGen consortium); prefrontal cortex eQTLs were measured from the PsychENCODE resource in 1387 individuals; and protein QTLs were measured in cerebral spinal fluid from 544 individuals and plasma from 818 individuals. Data were collected from October 4, 2019, to June 1, 2020, and analyzed from October 14, 2019, to June 6, 2020. Expression levels of antihypertensive drug target genes as proxies for drug exposure, and genetic variants robustly associated with the expression of these genes as mendelian randomization instruments. Risk for schizophrenia, bipolar disorder, and major depressive disorder. A 1-SD lower expression of the angiotensin-converting enzyme (ACE) gene in blood was associated with lower systolic blood pressure of 4.0 (95% CI, 2.7-5.3) mm Hg, but increased risk of schizophrenia (odds ratio [OR], 1.75; 95% CI, 1.28-2.38; P = 3.95 × 10-4). A concordant direction of association was also observed between ACE expression in prefrontal cortex (OR, 1.33; 95% CI, 1.13-1.56) and ACE protein levels in cerebral spinal fluid (OR per 1-SD decrease, 1.12; 95% CI, 1.05-1.19) and plasma (OR per 1-SD decrease, 1.04; 95% CI, 1.01-1.07). We found no evidence for an association between genetically estimated SBP and schizophrenia risk. Findings suggest an adverse association of lower ACE messenger RNA and protein levels with schizophrenia risk. These findings warrant greater pharmacovigilance and further investigation into the effect of ACE inhibitors, particularly those that are centrally acting, on psychiatric symptoms in patients with schizophrenia, as well as the role of ACE inhibitor use in late-onset schizophrenia.

Older Adults with First-Onset Schizophrenia: An Under-Recognized and Under-Served Patient Population

Schizophrenia is typically understood to be a disorder with onset in early adulthood, but nearly a quarter of patients are estimated to develop schizophrenia after age 40. Late-onset schizophrenia (patients with onset after age 40) and very-late onset schizophrenia (patients with onset after age 60) are historically an under-recognized and under-served population. Reasons for this are manifold, and may include barriers such as inconsistent terminology used to describe these patients, challenges with diagnosing, and lack of resources and research for these patients. To overcome these barriers, the DSM should include these subsets and provide clear diagnostic criteria. Incorporating these subsets into the learning objectives of medical school and residency programs would also promote further education and thus recognition of these patients. Finally, allocating funds towards resources and research in first-onset diagnosis of schizophrenia in adults over 40 would optimize treatment and improve understanding of this vulnerable patient population.

Cariprazine for late-life psychiatric illness: A review on therapeutic potential and challenges

Clinicians often face many challenges in the pharmacological treatment of late-life psychiatric illness especially while choosing an antipsychotic drug. The choice of antipsychotic is mostly guided by the extension of evidence from the adult population and tolerability. In India, based on evidence commonly prescribed antipsychotic drugs for older adults are quetiapine (QTP) followed by olanzapine (OLZN) and risperidone. Cariprazine is a newer antipsychotic that was recently launched in India. It is a novel mechanism of action at D3 receptors is known to have antidepressant and procognitive action in addition to the antipsychotic effects which is desirable in geriatric population. It can be a potential option as an add-on drug in late-life depression in addition to the existing aripiprazole and OLZN. The treatment of late-life mania and very late-onset schizophrenia is limited by the paucity of studies, with randomized control studies done only on QTP and amisulpride, respectively. Cariprazine can be considered in late-life psychotic disorders with the evidence available from its efficacy studies in adult patients. Merits of cariprazine are favorable metabolic profile, cardiac safety, and procognitive action. Demerits include extrapyramidal symptoms and fluctuations in blood pressure. Slower titration and monitoring for akathisia are recommended. There is a need for controlled studies in older adults with cariprazine to get better informed about its efficacy and safety.

Late schizophrenia

Introduction. The problem of late schizophrenia is one of the most controversial in clinicalpsychiatry. The organic factors that accompany the aging process make diagnosis difficult. Based on the consensus statement from an international group of experts in the field, this review discusses the features of schizophrenia in old age with a debut at a young age, late-onset schizophrenia (illness onset after 40 years of age) and very-late-onset schizophrenia-like psychosis (onset after 60 years). Method. The author conducted a study of MEDLINE sources on late schizophrenia.Results.This review provides data on the prevalence, neuroanatomy, pathogenesis, clinical presentation and treatment of schizophrenia in the elderly.Conclusion. Late schizophrenia is becoming a serious public health problem worldwide. Particularly relevant are the problems of the course of the disease, medical care and comorbidity in older psychiatric patients (general and illness-related), and treatment concerns related to the use of antipsychotics

Psychiatric Disorders in the Oldest-Old

The number of super-aged people over 80 years has increased with the life expectancy; however, studies on their psychiatric disorders are lacking. The characteristics of psychiatric disorders in the elderly are often complicated by physical diseases and organic changes in the brain. Psychiatric symptoms change atypically and rapidly. In the oldest-old, it is difficult to hear about the present condition of the patient and the aging process complicates drug therapy. In this paper, I outlined the diagnosis, symptoms, and treatments of: 1. psychotic disorders in the oldest-old including (A) schizophrenia comprised of (i) schizophrenia in late life and (ii) late-onset schizophrenia, (B) delusional disorder, (C) catatonia, and (D) late-onset psychotic disorders (conventional diagnosis); 2. depression; 3. apathy; 4. anxiety disorder; and 5. somatoform disorder.

The Gene Polymorphism of VMAT2 Is Associated with Risk of Schizophrenia in Male Han Chinese.

ObjectiveTo investigate the association between gene polymorphism of vesicular monoamine transporter type 2(VMAT2) and schizophrenia in Han Chinese population. Methods430 patients with schizophrenia and 470 age-sex matched controls were recruited from four mental health centers. All patients were diagnosed by two psychiatrists based on the Structured Clinical Interview for DSM Disorders (SCID). The ligase detection reactions (LDR) method was used to assess the polymorphism of the two SNPs (rs363371 and rs363324) of VMAT2. ResultsNo associations of two SNPs with schizophrenia was found. When we stratified males and females for the analysis, we found that that in the recessive model of rs363371, there was an obvious significant association between rs363371 and schizophrenia in males (OR=0.564, 95% CI=0.357–0.892, p=0.014) but not females. For the association between rs363324 and schizophrenia, no association was found in either males or females. No association was found when stratifying early-onset schizophrenia and late-onset schizophrenia. ConclusionOur findings indicate that both rs363371 and rs363324 were not associated with schizophrenia, while it seemed that the AA genotype of rs363371 plays a protective effect in male Chinese in developing schizophrenia.

414 - Rise in the number of geriatric patients attending psychiatric emergency services in a tertiary hospital during the COVID-19 lockdown period

Introduction: Older adults are at disproportionate risk of serious disease and mortality due to the novel coronavirus (COVID-19) pandemic. Further, the global response to the lockdown has rendered older adults particularly vulnerable to loneliness and social isolation due to the physical distancing and shelter in place mandate. We hypothesized that both these factors would lead to an increase in geriatric mental health problems during the COVID-19 pandemic.Material and Methods: We undertook a clinical audit of all geriatric patients (above 60 years of age) attending the psychiatry emergency services at a tertiary care hospital. This audit was conducted over a period of 52 days dating from the cessation of non-essential services at the hospital as part of the national response to the COVID-19 pandemic (lockdown).We used descriptive statistics to summarize the number, age, sex, presenting complaint and diagnoses of our patients. We further compared the average number of geriatric patients attending the psychiatry emergency services in the hospital during the lockdown to that of geriatric patients attending the same in the year before the lockdown.Results: A total of 112 geriatric patients attended the psychiatry emergency services during the lockdown period. Of these, 62 were male and 50 female. The average number of geriatric patients attending the emergency services daily during this period (μ1 2.15) was significantly higher (z 5.36, p ≤ 0.01) than the average number of patients attending the emergency services in the year preceding the lockdown (μ2 1.34).The most common presenting complaint was agitation in the preceding weeks. The most common diagnoses were late onset schizophrenia spectrum disorders followed by affective disorders and major neurocognitive disorders.Discussion: The COVID-19 pandemic and the global response to the same constitute life events for older adults. They may contribute to biological, psychological and social risk factors for mental health problems in older adults during this period. The increase in geriatric patients attending our emergency services, despite an increase in restrictions on mobility which act as barriers in the pathway to care, is worrying. Under stimulation in older adults during this period may contribute to an increase in agitation.

Independent living skills and cognition in early-onset and late-onset of schizophrenia patients: a pilot study

Aim. To evaluate cognitive functions and independent living skills in patients with late-onset schizophrenia (LOS) compared to patients with early-onset schizophrenia (EOS).&#x0D; Methods. The study included two clinical groups: 8 EOS patients (M=51.37.2; 7 males) and 8 LOS patients (M=67.89.9; 8 females), with comparable illness duration (22.69.1 and 19.911.9 respectively). Cognitive functions were assessed through the Brief Assessment of Cognition in Schizophrenia (BACS). The Autonomy Assessment Scale (AS) was used to measure independent living skills. The MannWhitney U-test was applied to determine differences between groups.&#x0D; Results. LOS group performed significantly better on Digit Sequencing Task, Verbal Fluency and Tower Test of the BACS. Composite score on AS was also significantly better in LOS group along with better scores on AS`s subscales assessing primarily social skills.&#x0D; Conclusion. LOS patients have milder cognitive dysfunction along with better independent living and social skills compared to AOS patients.

Comparative Study of Minor Physical Anomalies in Late Onset Schizophrenia

Comparative Study of Minor Physical Anomalies in Late Onset Schizophrenia