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Schizophrenia in the Elderly: Robustness of the Research Literature
The American psychiatric community has historically ignored the presence of schizophrenia in older adults, especially the elderly, because many researchers and clinicians had attributed the etiology of the disease to organic causes such as dementia (Howard, Rabins, Seeman, & Jeste, 2000). A substantial body of European studies, however, have revealed that a small percentage of schizophrenia patients experience their first symptoms of psychosis after the age of 60 independent of organic causes. The lack of progress in this area has been attributed to the nomenclature assigned to the different schizophrenia age groups, which remains confusing, with some research groups designating first diagnoses after the age of 40 as late-onset, while others set the age boundary at 55 or 60-years of age. The naming of the disease has also been confusing, with early researchers, such as Kraepelin in 1919, calling the condition paraphrenia to distinguish it from psychosis caused by dementia. The International Late-Onset Schizophrenia Group agreed that schizophrenia, regardless of the age of onset, is a heterogeneous disease and is more properly referred to as 'schizophrenias' or schizophrenia spectrum disorder. They also agreed to distinguish between late-onset schizophrenia, with a cutoff of 40-years of age, with very-late-onset schizophrenia-like psychosis with a cutoff of 60-years of age.
These problems continue to the plague the research literature, which tends to make it difficult to conduct systematic literature reviews on schizophrenia in the elderly. However, a search of Medline using the string "literature review AND late-onset schizophrenia" retrieved 62 citations. This essay will examine a few recent reviews as a way to evaluate the current state of research in this area.
Reviewing the Reviews
Although the International Late-Onset Schizophrenia Group provided nomenclature help, they also agreed that research in this area is lagging due in part to past disagreements on symptomology, nomenclature, and etiology (Howard, Rabins, Seeman, & Jeste, 2000). They reviewed published studies on this topic and some epidemiological and treatment data was available to the group in 1998, but the quality and consistency of the findings were generally low. Their recommendations included future research in epidemiology, symptomology, pathophysiology, etiology, and treatment, because so little is known about this disease in aging adults.
More recently, a systematic review of late-onset schizophrenia in the elderly focused on the issue of antipsychotic medication use (Essali & Ali, 2012).…
References
Howard, R., Rabins, P.V., Seeman, M.V., & Jeste, D.V. (2000). Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: An international consensus. The International Late-Onset Schizophrenia Group. American Journal of Psychiatry, 157(2), 172-178.
Essali, A. & Ali, G. (2012). Antipsychotic drug treatment for elderly people with late-onset schizophrenia. Cochrane Database of Systematic Reviews, 2, 1-67.
Schizophrenia Psychosis and Lifespan D Schizophrenia and Psychosis and Lifespan Development Schizophrenia and Psychosis Matrix Disorder Major DSM-IV-TR Categories Classifications Subclassifications Schizophrenia and Psychosis Symptoms Positive (Type I): represent excesses or distortions from normal functioning Delusions Bizarre Nonbizarre Hallucinations Auditory Visual Disorganized Speech Loose Association Neologisms Clang Associations Echolalia/Echopraxia Word Salad Grossly disorganized behavior Catatonic: motoric Waxy Flexibility Negative (Type II): the absence of functioning Apathy Affective Flattening Withdrawal Anhedonia Avolition Poor Concentration Poverty of speech Alogia Schizophrenia and Psychosis Diagnostic Types Paranoid Delusions and Hallucinations Disorganized Disorganized speech Disorganized behavior Withdrawal Affective flattening Catatonic Grossly disorganized behavior Disorganized speech Catatonic Echolalia/Echopraxia Undifferentiated Active symptoms that do not fit other diagnostic types Residual No Type I symptoms but some negative symptoms Schizoaffective
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