Schizophrenia and delusional disorders with onset in later life

Abstract

Keywords Resumo DescritoresSchizophrenia-spectrum illness is most commonly associated with an onset in early adulthood. When nonaffective psychotic symptoms emerge for the first time in later life, the clinical presentation has both similarities and differences with earlier-onset syndromes. This situation has resulted in continuing debate about the nosological status of late-onset psychosis, and whether there are particular risk factors associated with this latelife peak in incidence. Although early cognitive decline is frequently identified in these patients, studies, to date, have not established if there is a relationship with the dementing illnesses of old age. Sensory impairment, social isolation, and a family history of schizophrenia have been associated with late-onset psychosis, but appear to exert a nonspecific influence on vulnerability. While diagnostic issues remain unresolved, clinicians need to formulate treatment strategies that most appropriately address the constellation of symptoms in the clinical presentation of their psychotic elderly patients.Schizophrenia. Psychotic disorders. Psychoses. Cognition. Social isolation. Aged. Transtornos mentais do espectro da esquizofrenia são comumente associados a início na primeira fase da vida adulta. Quando sintomas psicóticos não-afetivos emergem pela primeira vez em fases tardias da vida, a apresentação clínica tem semelhanças e diferenças em relação às

Very Late Onset Schizophrenia like Psychosis at Eighties: A Case Vignette and Comprehensive Literature Review

“…Pearlson et al defined these phenomena as "the delusion that people, gas, electricity, or some other force was entering their home through the walls from a neighbouring dwelling" [12]. Social isolation has been cited as a possible predisposing factor for the development of these phenomena [13] which might have contributed to our patient's partition delusion. While females dominate in prevalence, family history studies suggest that, while hereditary factors are present, they are less influential than in earlier-onset schizophrenia [14].…”

“…The diagnosis of very late-onset schizophrenia like psychosis has been proposed for patients who experience the onset of symptoms after the age of 60 years [1] and they present with some characteristics similar to those of early-onset schizophrenia in terms of psychopathology, non-specific brainimaging abnormalities, course of illness, and treatment response [2]. Importantly the emergence of psychotic symptoms for the first time in later life poses a diagnostic challenge for clinicians in assessment of elderly persons with mental illness as they are frequently confronted with issues relating to cognitive deficits, affective symptomatology, and physical illness [3]. Most commonly, late onset delusions and hallucinations are associated with dementing and affective disorders; however, in a small but substantial number of cases these symptoms arise de novo [3].…”

“…Importantly the emergence of psychotic symptoms for the first time in later life poses a diagnostic challenge for clinicians in assessment of elderly persons with mental illness as they are frequently confronted with issues relating to cognitive deficits, affective symptomatology, and physical illness [3]. Most commonly, late onset delusions and hallucinations are associated with dementing and affective disorders; however, in a small but substantial number of cases these symptoms arise de novo [3].…”

Risk factors for the late‐onset psychoses: a systematic review of cohort studies

“…To our knowledge, no systematic review or meta‐analysis has been published on risk factors for late‐onset psychoses identified by cohort studies. Although some interesting reviews are available (Grahame, ; Harris, ; Castle and Murray, ; Almelda et al , ; Henderson and Kay, ; Wynn Owen and Castle, ; Howard et al , ; Hassett, ), most of the studies included in these reviews have cross‐sectional designs, not the best design to assess causality (Gray, ). Women seem to be overrepresented among subjects with late‐onset psychosis (Kay, ; Herbert and Jacobson, ; Grahame, ; Castle et al , ).…”

“…Aging appears to be associated with a higher risk, such that each 5‐year increase after 65 years old is associated with an 11% rise in the annual incidence (Van Os et al , ). Hearing deficiency has long been implicated, but its role is now debated (Howard et al , ; Hassett, ). Subtle brain lesions and cognitive abnormalities are more frequent in older patients with psychosis, but evidence is lacking to support definite association with a dementia process (Howard et al , ).…”