Schizophrenia in elderly, managing old age psychotic disorder

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Managing the psychotic disorder schizophrenia in the elderly is important but also faces many challenges. Anyone at any age can experience schizophrenia, but age can be a large factor in the effectiveness of treatment. For example, antipsychotic drugs can pose adverse effects in the elderly, even though they can have minimal side effects in younger patients. For this reason, it becomes more challenging to treat schizophrenia in the elderly.

Research has shown that the use of antipsychotic drugs should be lower when used in the elderly in order to minimize adverse side effects.

Aging and schizophrenia

It has been shown that schizophrenia speeds up physical aging in comparison to the general population. It has also been shown that the average life span of a person with schizophrenia is 20 to 23 years shorter than the general population. Basically, a schizophrenic person in their 40s and 50s will have comparable health to a person in their 60s and 70s.

Difference between early-onset, late-onset and very late-onset schizophrenia

Early-Onset Schizophrenia, Late-Onset Disease
and Very Late-Onset Schizophrenia-Like Psychosis
“A closer look at the defining characteristics.” Early-Onset
Schizophrenia Late-Onset
Schizophrenia Very Late-Onset Schizophrenia-Like Psychosis Age of onset Younger than age 40 Middle age (age 40 to 65) Late life (older than age 65) Predominant gender Men Women Women Paranoid subtype Common Very common Common Negative symptoms Marked Present Absent Thought disorder Present Present Absent Minor physical anomalies Present Present Absent Brain structure abnormalities
(e.g., strokes, tumors) Absent Absent Marked Neuropsychological impairment:
Learning
Retention Marked
Absent Present
Absent Probably marked
Probably marked Progressive cognitive deterioration Absent Absent Marked Family history of schizophrenia Present Present Absent Early childhood maladjustment Present Present Absent Risk of tardive dyskinesia Present Present Marked Daily neuroleptic dose High Lower Lowest

Difference between early-onset, late-onset and very late-onset schizophrenia. Download comparison chart (JPG)

Adapted from Palmer BW, McClure FS, Jeste DV. Schizophrenia in late life: findings challenge traditional concepts. Harv Rev Psychiatry 2001;9(2):51-8.

Risk factors for schizophrenia in older people

Risk factors for schizophrenia in older people include:

• Family history
• Sensory deficits
• Social isolation
• Premorbid personality disorder
• Neuropsychological abnormalities
• Being female

Causes and symptoms of schizophrenia in the elderly

As with many mental disorders, there is no exact pinpointed cause of schizophrenia but several factors come into play. Genes, chemical imbalances in the brain, family relationships, environments and the use of drugs are all factors that can contribute to the onset of schizophrenia.

Symptoms of schizophrenia include:

• Delusions
• Hallucinations
• Disorganized thinking
• Disorganized and abnormal motor behavior
• Negative symptoms – lack of ability to function normally, lack of emotion, lack of expression, etc.

Treatment of schizophrenia in the elderly

With proper treatment individuals with schizophrenia can live a normal life and, even though there is no cure, symptoms can be well-managed. Medications are often diagnosed to relieve hallucinations and delusions. Antipsychotics, in particular, can help with any chemical imbalances in the brain. Unfortunately, as with any medication there is the risk of side effects – especially in the elderly.

Common side effects experienced by the elderly due to the use of antipsychotic drugs are:

• Uncontrolled movements
• Weight gain
• Drowsiness
• Dizziness
• Restlessness
• Dry mouth
• Constipation
• Nausea
• Vomiting
• Blurred vision
• Low blood pressure
• Seizures
• Low white blood cell count
• Sexual dysfunction

There are non-drug treatments, too, like seeking out therapy, either one-on-one or group-based. Different types of therapy to treat schizophrenia include:

• Cognitive behavioral therapy
• Self-help groups
• Family therapy
• Rehabilitation
• Integrated substance abuse treatment

By integrating a combination of medical and non-medical treatments a person with schizophrenia can very well live a normal life.

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