Late-onset schizophrenia

Although schizophrenia with onset in middle or late-life is a relatively uncommon, a considerable proportion of patients do experience the first manifestations of the disease after the age of forty. The current nomenclature utilizes terminology based on age at onset: late-onset schizophrenia (LOS) for illness with onset between ages 40 and 60, and very-late-onset schizophrenia-like psychosis (VLOSLP) for onset after age 60. Recent evidence suggests more similarities than differences in epidemiology, etiology or risk factors and clinical presentation between these clinical entities, although a later onset seems to be associated with better premorbid functioning and female gender. Relatively stable cognitive deficits are observed in patients regardless of age at onset and LOS is generally not associated with a dementia, although VLOSLP are more likely to be associated with neurodegenerative processes. Antipsychotic medication is the mainstay of treatment and some psychosocial interventions may prove beneficial, but there is a lack of clinical trials focused on patients with onset in late-life. Response to treatment and outcomes tend to be better than among those with earlier onset, but special consideration should be given to biological and psychosocial factors related to the older age of patients