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Issue: Issue 5 – 2018


Review Article

Late-onset schizophrenia: from Manfred Bleuler to the present

Author(s):
Ana Dias-Amaral, Maria João Peixoto, Alzira Silva, and Rui Coelho
Abstract:
Background: For Bleuler, late-onset schizophrenia (LOS) was characterized by onset after age 40, symptoms similar to the classic form and absence of signs of organic brain disease. We aim to describe the current aetiology, diagnosis and treatment of LOS, emphasizing the differences between LOS and classic schizophrenia. 
Methods: Non-systematic review of original articles and systematic reviews regarding late-onset schizophrenia aetiology, diagnosis and treatment indexed to Pubmed, ISI – Web of Knowledge, Scopus and EBSCO published between January 1980 and December 2017, using the MeSH query: schizophrenia AND late onset disorders. Altogether, 62 articles were deemed relevant by two independent reviewers and included in the final selection. 
Results: 23% of the cases of schizophrenia have late- (> 40 years) or very late-onset (> 60 years), with higher incidence in females. Genetic factors, menopause, sensory deficits, vascular and neurodegenerative lesions, and age per se are risk factors. Higher educational levels and marital rates and greater cognitive reserve stand out. Well systematized persecutory and jealousy delusions and auditory hallucinations are common. On the contrary, negative symptoms are uncommon. Cognitive functions are well preserved in the first year, but high rates of dementia are described after five-year follow-up. Due to the protective effect of oestrogen, LOS appears to have a worse prognosis in postmenopausal women. Despite the anti-psychotic drugs available, most patients remain symptomatic. 
Conclusion: There is a significant overlap between early-onset schizophrenia and LOS/very-late onset schizophrenia-like psychosis (VLOSLP), but there are important differences mainly regarding risk factors and symptoms that cannot be overlooked. Seventy-five years after the first description, it is necessary to better define LOS/VLOSLP as a debate identity.

Keywords: Schizophrenia, Psychosis, Late-onset.

International Journal of Clinical Neurosciences and Mental Health 2018; 5:4
DOI: https://doi.org/10.21035/ijcnmh.2018.5.4
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