Skip to main content
SpringerLink
Log in

Schizophrenia and Other Late-Life Psychoses

  • Reference work entry
  • First Online:
Geriatric Medicine

Abstract

Psychotic symptoms in late life can be intrinsic to underlying psychiatric disorders (as in the case of schizophrenia and other psychiatric conditions) or secondary to other factors (e.g. neurodegenerative disorders, medical comorbidities, drug effects). Such circumstance makes psychosis a condition which clinicians working in the field of geriatric medicine should be prepared to clinically assess, manage, and treat. In the present chapter, information on schizophrenia and other forms of psychoses is provided, with a focus on evidence related to the field of geriatric medicine.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Abbreviations

AD:

Alzheimer’s Disease

BD:

Bipolar Disorder

DD:

Delusional Disorder

DSM5:

Statistical Manual of Mental Disorders – 5th Edition

ECT:

Electroconvulsive Therapy

FGA:

First Generation Antipsychotic

FTD:

Frontotemporal Dementia

ICD11:

International Classification of Diseases 11th Edition

LBD:

Lewy Body Dementia

MDD:

Major Depression Disorder

OCD:

Obsessive Compulsive Disorder

PD:

Parkinson’s Disease

SCZ:

Schizophrenia

SGA:

Second Generation Antipsychotic

VD:

Vascular Dementia

VLOSP:

Very Late-Onset Schizophrenia-Like Psychosis

References

  1. Tandon R, et al. Definition and description of schizophrenia in the DSM-5. Schizophr Res. 2013;150(1):3–10.

    Article  PubMed  Google Scholar 

  2. Fusar-Poli P, Politi P. Paul Eugen Bleuler and the birth of schizophrenia (1908). Am J Psychiatry. 2008;165(11):1407.

    Article  PubMed  Google Scholar 

  3. Hany M, et al. Schizophrenia. 2020. https://pubmed.ncbi.nlm.nih.gov/30969686/

  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  5. van Os J, Kapur S. Schizophrenia. Lancet. 2009;374(9690):635–45.

    Article  PubMed  Google Scholar 

  6. Arciniegas DB. Psychosis. Continuum (Minneap Minn). 2015;21(3 Behavioral Neurology and Neuropsychiatry):715–36.

    PubMed  Google Scholar 

  7. Burgy M. The concept of psychosis: historical and phenomenological aspects. Schizophr Bull. 2008;34(6):1200–10.

    Article  PubMed  PubMed Central  Google Scholar 

  8. The National Institute of Mental Health Information Resource Center. What is psychosis? 2020. https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-psychosis.shtml

  9. Picchioni MM, Murray RM. Schizophrenia. BMJ. 2007;335(7610):91–5.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lieberman JA, et al. The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biol Psychiatry. 2001;50(11):884–97.

    Article  CAS  PubMed  Google Scholar 

  11. Correll CU, Schooler NR. Negative symptoms in schizophrenia: a review and clinical guide for recognition, assessment, and treatment. Neuropsychiatr Dis Treat. 2020;16:519–34.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Owen MJ, Sawa A, Mortensen PB. Schizophrenia. Lancet. 2016;388(10039):86–97.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Arnedo J, et al. Uncovering the hidden risk architecture of the schizophrenias: confirmation in three independent genome-wide association studies. Am J Psychiatry. 2015;172(2):139–53.

    Article  PubMed  Google Scholar 

  14. Maglione JE, Thomas SE, Jeste DV. Late-onset schizophrenia: do recent studies support categorizing LOS as a subtype of schizophrenia? Curr Opin Psychiatry. 2014;27(3):173–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gogos A, et al. A role for Estrogen in schizophrenia: clinical and preclinical findings. Int J Endocrinol. 2015;2015:615356.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Piotrowski P, et al. Causes of mortality in schizophrenia: an updated review of European studies. Psychiatr Danub. 2017;29(2):108–20.

    Article  PubMed  Google Scholar 

  17. Castle DJ, Murray RM. The epidemiology of late-onset schizophrenia. Schizophr Bull. 1993;19(4):691–700.

    Article  CAS  PubMed  Google Scholar 

  18. Tampi RR, et al. Psychotic disorders in late life: a narrative review. Ther Adv Psychopharmacol. 2019;9:2045125319882798.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Copeland JR, et al. Schizophrenia and delusional disorder in older age: community prevalence, incidence, comorbidity, and outcome. Schizophr Bull. 1998;24(1):153–61.

    Article  CAS  PubMed  Google Scholar 

  20. Reinhardt MM, Cohen CI. Late-life psychosis: diagnosis and treatment. Curr Psychiatry Rep. 2015;17(2):1.

    Article  PubMed  Google Scholar 

  21. Arnold I, et al. Old age bipolar disorder-epidemiology, aetiology and treatment. Medicina (Kaunas). 2021;57(6):587.

    Article  PubMed  Google Scholar 

  22. Vermeulen T, et al. Cognitive deficits in older adults with psychotic depression: a meta-analysis. Am J Geriatr Psychiatry. 2019;27(12):1334–44.

    Article  PubMed  Google Scholar 

  23. Joseph SM, Siddiqui W. Delusional disorder. In: StatPearls. Treasure Island: StatPearls Publishing; 2022.

    Google Scholar 

  24. Nagendra J, Snowdon J. An Australian study of delusional disorder in late life. Int Psychogeriatr. 2020;32(4):453–62.

    Article  PubMed  Google Scholar 

  25. Zhao QF, et al. The prevalence of neuropsychiatric symptoms in Alzheimer’s disease: systematic review and meta-analysis. J Affect Disord. 2016;190:264–71.

    Article  PubMed  Google Scholar 

  26. Anor CJ, et al. Neuropsychiatric symptoms in Alzheimer disease, vascular dementia, and mixed dementia. Neurodegener Dis. 2017;17(4–5):127–34.

    Article  PubMed  Google Scholar 

  27. Jacobson SA, et al. Plaques and tangles as well as Lewy-type alpha synucleinopathy are associated with formed visual hallucinations. Parkinsonism Relat Disord. 2014;20(9):1009–14.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Olney NT, Spina S, Miller BL. Frontotemporal dementia. Neurol Clin. 2017;35(2):339–74.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Levin J, Hasan A, Hoglinger GU. Psychosis in Parkinson’s disease: identification, prevention and treatment. J Neural Transm (Vienna). 2016;123(1):45–50.

    Article  CAS  PubMed  Google Scholar 

  30. Keshavan MS, Kaneko Y. Secondary psychoses: an update. World Psychiatry. 2013;12(1):4–15.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Davis J, et al. A review of vulnerability and risks for schizophrenia: beyond the two hit hypothesis. Neurosci Biobehav Rev. 2016;65:185–94.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Gejman PV, Sanders AR, Duan J. The role of genetics in the etiology of schizophrenia. Psychiatr Clin North Am. 2010;33(1):35–66.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Carroll LS, Owen MJ. Genetic overlap between autism, schizophrenia and bipolar disorder. Genome Med. 2009;1(10):102.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Stilo SA, Murray RM. Non-genetic factors in schizophrenia. Curr Psychiatry Rep. 2019;21(10):100.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Howes O, McCutcheon R, Stone J. Glutamate and dopamine in schizophrenia: an update for the 21st century. J Psychopharmacol. 2015;29(2):97–115.

    Article  PubMed  PubMed Central  Google Scholar 

  36. McCutcheon RA, Krystal JH, Howes OD. Dopamine and glutamate in schizophrenia: biology, symptoms and treatment. World Psychiatry. 2020;19(1):15–33.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kapur S, Remington G. Serotonin-dopamine interaction and its relevance to schizophrenia. Am J Psychiatry. 1996;153(4):466–76.

    Article  CAS  PubMed  Google Scholar 

  38. Muller N, et al. The role of inflammation in schizophrenia. Front Neurosci. 2015;9:372.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Szeligowski T, et al. The gut microbiome and schizophrenia: the current state of the field and clinical applications. Front Psych. 2020;11:156.

    Article  Google Scholar 

  40. Bradley AJ, Dinan TG. A systematic review of hypothalamic-pituitary-adrenal axis function in schizophrenia: implications for mortality. J Psychopharmacol. 2010;24(4 Suppl):91–118.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Keshavan MS, et al. Neuroimaging in schizophrenia. Neuroimaging Clin N Am. 2020;30(1):73–83.

    Article  PubMed  Google Scholar 

  42. Stephan KE, Friston KJ, Frith CD. Dysconnection in schizophrenia: from abnormal synaptic plasticity to failures of self-monitoring. Schizophr Bull. 2009;35(3):509–27.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Friston K, et al. The dysconnection hypothesis. Schizophr Res. 2016;176(2–3):83–94.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bachmann S, et al. Neurological soft signs in the clinical course of schizophrenia: results of a meta-analysis. Front Psych. 2014;5:185.

    Google Scholar 

  45. American Psychiatric Association. Highlights of changes from DSM-IV-TR to DSM-5. Arlington: American Psychiatric Publishing; 2013.

    Google Scholar 

  46. McCutcheon RA, Keefe RSE, McGuire PK. Cognitive impairment in schizophrenia: aetiology, pathophysiology, and treatment. Mol Psychiatry. 2023;28(5):1902–18.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Larson MK, Walker EF, Compton MT. Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders. Expert Rev Neurother. 2010;10(8):1347–59.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Fusar-Poli P, et al. The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry. 2013;70(1):107–20.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Wilson JE, et al. Pseudodelirium: psychiatric conditions to consider on the differential for delirium. J Neuropsychiatry Clin Neurosci. 2021;33(4):356–64.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Cipriani G, et al. A contagious disorder: Folie a Deux and dementia. Am J Alzheimers Dis Other Dement. 2018;33(7):415–22.

    Article  Google Scholar 

  51. Suen YN, et al. Late-onset psychosis and very-late-onset-schizophrenia-like-psychosis: an updated systematic review. Int Rev Psychiatry. 2019;31(5–6):523–42.

    Article  CAS  PubMed  Google Scholar 

  52. Harrison PJ, et al. Innovative approaches to bipolar disorder and its treatment. Ann N Y Acad Sci. 2016;1366(1):76–89.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Casagrande Tango R. Psychiatric side effects of medications prescribed in internal medicine. Dialogues Clin Neurosci. 2003;5(2):155–65.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Drugs that may cause psychiatric symptoms. Med Lett Drugs Ther. 2008;50 1301–1302:100–3; quiz p-p 2 following 104.

    Google Scholar 

  55. World Health Organization. ICD-11: international classification of diseases, 11th revision. 2019.

    Google Scholar 

  56. Lay B, Roser P, Kawohl W. Inpatient treatment of people with schizophrenia: quantifying clinical change using the health of the nation outcome scales. Schizophr Bull Open. 2021;2(1):sgab030. https://academic.oup.com/schizbullopen/article/2/1/sgab030/6316213?login=false

  57. Mailman RB, Murthy V. Third generation antipsychotic drugs: partial agonism or receptor functional selectivity? Curr Pharm Des. 2010;16(5):488–501.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Seifert R, Schirmer B. A simple mechanistic terminology of psychoactive drugs: a proposal. Naunyn Schmiedeberg’s Arch Pharmacol. 2020;393(8):1331–9.

    Article  CAS  Google Scholar 

  59. Thornton AE, et al. The impact of atypical antipsychotic medications on long-term memory dysfunction in schizophrenia spectrum disorder: a quantitative review. J Psychopharmacol. 2006;20(3):335–46.

    Article  CAS  PubMed  Google Scholar 

  60. Adams CE, et al. Systematic meta-review of depot antipsychotic drugs for people with schizophrenia. Br J Psychiatry. 2001;179:290–9.

    Article  CAS  PubMed  Google Scholar 

  61. Remington G, et al. Guidelines for the pharmacotherapy of schizophrenia in adults. Can J Psychiatr. 2017;62(9):604–16.

    Article  Google Scholar 

  62. Biondi M, Pasquini M, Picardi A. Dimensional psychopathology. Cham: Springer International Publishing; 2018.

    Book  Google Scholar 

  63. Stroup TS, Gray N. Management of common adverse effects of antipsychotic medications. World Psychiatry. 2018;17(3):341–56.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Ali SA, et al. Electroconvulsive therapy and schizophrenia: a systematic review. Mol Neuropsychiatry. 2019;5:75–83.

    PubMed  PubMed Central  Google Scholar 

  65. Dragioti E, et al. Impact of mental disorders on clinical outcomes of physical diseases: an umbrella review assessing population attributable fraction and generalized impact fraction. World Psychiatry. 2023;22(1):86–104.

    Article  PubMed  PubMed Central  Google Scholar 

  66. World Health Organization. Guidelines for the management of physical health conditions in adults with severe mental disorders. Geneva: WHO; 2018.

    Google Scholar 

  67. Alexopoulos GS, et al. Using antipsychotic agents in older patients. J Clin Psychiatry. 2004;65(Suppl 2):5–99; discussion 100–2; quiz 103–4.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

    Francesco Saverio Bersani & Elisabeth Prevete

  2. Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA

    Roberto Vicinanza

Authors
  1. Francesco Saverio Bersani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elisabeth Prevete
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto Vicinanza
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Saverio Bersani .

Editor information

Editors and Affiliations

  1. California Association of Long Term Care Medicine, Newbury Park, CA, USA

    Michael R. Wasserman

  2. Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA

    Debra Bakerjian

  3. Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA

    Sunny Linnebur

  4. Division of Geriatrics, SUNY Upstate Medical University, Syracuse, NY, USA

    Sharon Brangman

  5. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Matteo Cesari

  6. Section of Geriatric Medicine, Division of Internal Medicine, Department of Medicine, Cedars-Sinai, Beverly Hills, CA, USA

    Sonja Rosen

Section Editor information

  1. Department of Clinical Pharmacy, University of Colorado School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA

    Sunny Linnebur PharmD

Rights and permissions

Reprints and permissions

Copyright information

© 2024 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Bersani, F.S., Prevete, E., Vicinanza, R. (2024). Schizophrenia and Other Late-Life Psychoses. In: Wasserman, M.R., Bakerjian, D., Linnebur, S., Brangman, S., Cesari, M., Rosen, S. (eds) Geriatric Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-74720-6_87

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-74720-6_87

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-74719-0

  • Online ISBN: 978-3-030-74720-6

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation