Drugs & Aging

, Volume 15, Issue 2, pp 81–89 | Cite as

Late-Onset Schizophrenia

Epidemiology, Diagnosis, Management and Outcomes
  • Peter A. Wynn Owen
  • David J. CastleEmail author
Disease Management


The onset of schizophrenia for the first time in late life has been considered rare, and the nosology of the late-onset functional psychoses remains contentious. However, it is clear that a significant proportion of individuals with a diagnosis of schizophrenia do have the first onset of the illness in late and very late life. The clinical presentation of such patients shows some differences from patients with early-onset disease, particularly in having a lower prevalence of premorbid dysfunction, negative symptoms and formal thought disorder. The longitudinal course is variable, possibly a reflection of aetiological heterogeneity. Atypical antipsychotic agents would appear to have significant benefits in the treatment of this group of patients, given the particular vulnerability of the elderly to extrapyramidal adverse effects, notably tardive dyskinesia.


Schizophrenia Adis International Limited Clozapine Psychotic Symptom Tardive Dyskinesia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Feighner JP, Robins E, Guze SB, et al. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry 1972; 26: 57–63PubMedCrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Press, 1987Google Scholar
  3. 3.
    Roth M. The natural history of mental disorder in old age. J Ment Sci 1955; 101: 281–301PubMedGoogle Scholar
  4. 4.
    World Health Organization (WHO). International classification of diseases. 9th ed. Geneva: WHO, 1978Google Scholar
  5. 5.
    Keith SJ, Regier DA, Rae DS. Schizophrenic disorders. In: Robins LN, Regier DA, editors. Psychiatric disorders in America. New York: Free Press, 1991Google Scholar
  6. 6.
    Tien AY. Distributions of hallucinations in the population. Soc Psychiatry Psychiatr Epidemiol 1991; 26: 287–92PubMedCrossRefGoogle Scholar
  7. 7.
    Christenson R, Blazer D. Epidemiology of persecutory ideation in an elderly population in the community. Am J Psychiatry 1984; 9(141): 1088–91Google Scholar
  8. 8.
    Henderson AS, Korten AE, Levings C, et al. Psychotic symptoms in the elderly: a prospective study in a population sample. Int J Geriatr Psychiatry 1998; 13(7): 484–92PubMedCrossRefGoogle Scholar
  9. 9.
    Harris MJ, Jeste DV. Late-onset schizophrenia: an overview. Schizophr Bull 1988; 14(1): 39–55PubMedGoogle Scholar
  10. 10.
    Castle DJ, Murray RM. The epidemiology of late-onset schizophrenia. Schizophr Bull 1993; 19(4): 691–9PubMedGoogle Scholar
  11. 11.
    Parsons PL. Mental health of Swansea’s old folk. Br J Prev Soc Med 1964; 19: 43–7Google Scholar
  12. 12.
    Williamson J, Stokoe IH, Gray S, et al. Old people at home: their unreported needs. Lancet 1964; I: 1117–20CrossRefGoogle Scholar
  13. 13.
    Castle DJ. Gender and age at onset in schizophrenia. In: Howard R, Rabins P, editors. Late life schizophrenia: an international perspective. In pressGoogle Scholar
  14. 14.
    McLachlan G, Wekham J, McGrath J. Heterogeneity in schizophrenia: a mixture model based on age-of-onset, gender and diagnosis [abstract]. Schizophr Res 1998; 29: 21CrossRefGoogle Scholar
  15. 15.
    Castle DJ, Wessely S, Howard R, et al. Schizophrenia with onset at the extremes of adult life. Int J Geriatr Psychiatry 1997; 12: 712–7PubMedCrossRefGoogle Scholar
  16. 16.
    Howard R, Castle DJ, O’Brien J, et al. Permeable walls, floors, ceilings and doors: partition delusions in late paraphrenia. Int J Geriatr Psychiatry 1992; 7: 719–24CrossRefGoogle Scholar
  17. 17.
    Pearlson GD, Kreger L, Rabins PV, et al. A chart review study of late-onset and early-onset schizophrenia. Am J Psychiatry 1989; 146(12): 1568–74PubMedGoogle Scholar
  18. 18.
    Rabins P, Pauker S, Thomas J. Can schizophrenia begin after 44? Compr Psychiatry 1984; 25(3): 290–3PubMedCrossRefGoogle Scholar
  19. 19.
    Wragg RE, Jeste DV. Overview of depression and psychosis in Alzheimer’s disease. Am J Psychiatry 1989; 146: 577–87PubMedGoogle Scholar
  20. 20.
    Castle DJ, Howard R. What do we know about the aetiology of late-onset schizophrenia? Eur Psychiatry 1992; 7: 99–108Google Scholar
  21. 21.
    Howard R, Graham C, Sham P, et al. A controlled family study of late-onset non-affective psychosis (late paraphrenia). Br J Psychiatry 1997; 170: 511–4PubMedCrossRefGoogle Scholar
  22. 22.
    Prager S, Jeste DV. Sensory impairment in late-life schizophrenia. Schizophr Bull 1993; 19(4): 755–71PubMedGoogle Scholar
  23. 23.
    Fish F. Senile schizophrenia. J Ment Sci 1960; 106: 938–46PubMedGoogle Scholar
  24. 24.
    Kay DWK, Roth M. Environmental and hereditary factors in the schizophrenias of old age (‘late paraphrenia’) and their bearing on the general problem of causation in schizophrenia. J Ment Sci 1961; 107: 649–86PubMedGoogle Scholar
  25. 25.
    Kay DWK. Late paraphrenia and its bearing on the aetiology of schizophrenia. Acta Psychiatr Scand 1963; 39: 159–69PubMedCrossRefGoogle Scholar
  26. 26.
    Almieda OP, Howard R, Forstl H, et al. Late paraphrenia: a review. Int J Geriatr Psychiatry 1992; 7: 543–8CrossRefGoogle Scholar
  27. 27.
    Holden NL. Late paraphrenia or the paraphrenias? A descriptive study with 10-year follow-up. Br J Psychiatry 1987; 150: 635–9PubMedCrossRefGoogle Scholar
  28. 28.
    Häfner H, Hambrecht M, Löffler W, et al. Is schizophrenia a disorder of all ages? A comparison of first episodes and early course across the life-cycle. Psychol Med 1998; 28: 351–65PubMedCrossRefGoogle Scholar
  29. 29.
    Eaton WW, Mortensen PB, Herrman H, et al. Long-term course for hospitalisation in schizophrenia. Schizophr Bull 1992; 18: 217–28PubMedGoogle Scholar
  30. 30.
    Sciolla A, Jeste DV. Use of antipsychotics in the elderly. Int J Psychiatry Clin Pract 1998; 2Suppl. 1: S27–34Google Scholar
  31. 31.
    Sweet RA, Pollock BG. New atypical antipsychotics: experience and utility in the elderly. Drugs Aging 1998; 12(2): 115–27PubMedCrossRefGoogle Scholar
  32. 32.
    Jeste DV, Caligiuri MP, Paulsen AS, et al. Risk of tardive dyskinesia in older patients: a prospective longitudinal study of 266 patients. Arch Gen Psychiatry 1995; 52: 756–65PubMedCrossRefGoogle Scholar
  33. 33.
    Jeste DV, Eastham JH, Lacro JP, et al. Management of late-life psychosis. J Clin Psychiatry 1996; 57Suppl. 3: 39–45PubMedGoogle Scholar
  34. 34.
    Herst L, Powell G. Is clozapine safe in the elderly? Aust N Z J Psychiatry 1997; 31: 411–17PubMedCrossRefGoogle Scholar
  35. 35.
    Sajatovic M, Ramirez L, Garver D, et al. Clozapine therapy for older veterans. Psychiatr Serv 1998; 49(3): 340–4PubMedGoogle Scholar
  36. 36.
    Salzman C, Vaccaro B, Lieff J, et al. Clozapine in older patients with psychosis and behavioural disruption. Am J Geriatr Psychiatry 1995; 3: 26–33Google Scholar
  37. 37.
    Wolters EC, Jansen ENH, Tuynman-Qua HG, et al. Olanzapine in the treatment of dopaminomimetic psychosis in patients with Parkinson’s disease. Neurology 1996; 47: 1085–7PubMedCrossRefGoogle Scholar
  38. 38.
    Daniel DG, Wozniak P, Mack RJ, the Sertindole Study Group, et al. Long-term efficacy and safety comparison of sertindole and haloperidol in the treatment of schizophrenia. Psychopharmacol Bull 1998; 34(1): 61–9PubMedGoogle Scholar
  39. 39.
    Arvanitis LA, Miller BG, the Seroquel Trial 13 Study Group. Multiple fixed doses of ‘seroquel’(quetiapine) in patients with acute exacerbation of schizophrenia: a comparison with haloperidol and placebo. Biol Psychiatry 1997; 42(4): 233–46PubMedCrossRefGoogle Scholar
  40. 40.
    Wong SL, Cao G, Mack RJ, et al. Pharmacokinetics of sertindole in healthy young and elderly male and female subjects. Clin Pharmacol Ther 1997; 62(2): 157–64PubMedCrossRefGoogle Scholar
  41. 41.
    Leucht S, Pitshel-Walz G, Abraham D, et al. Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone and sertindole compared to conventional antipsychotics and placebo: a meta-analysis of randomised controlled trials. Schizophr Res 1999; 4; 35: 51–68CrossRefGoogle Scholar

Copyright information

© Adis International Limited 1999

Authors and Affiliations

  1. 1.Directorate of Mental Health ServicesFremantle Hospital and Health Service, Alma Street CentreFremantleAustralia

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