Because the risk of schizophrenia declines with maturity, late-onset diagnoses at about age 45 are rare. These patients, mostly women, have fewer negative symptoms and better prognoses with treatment than middle-aged men and those diagnosed at typical adolescent or early adulthood ages.
Age and Gender Distinctions
While schizophrenia is the most common psychotic condition, only 10 to 15 percent of adults develop it in later adulthood. Late-onset schizophrenia occurs between ages 40 and 60. In a study of 194 patients ranging from 35 to 97, about 37 percent of the women developed schizophrenia at 45, compared to just 16 percent of the men. Often very-late-onset schizophrenia after age 60 is due to dementia, Parkinson’s disease or stroke. These additional conditions complicate elderly symptoms and treatments. Studies suggest women cope with schizophrenia and respond to anti-psychotics better than men. Middle-aged women also have an overall higher recovery rate than other age groups.
Early-Onset Schizophrenia Symptoms
This syndrome’s disordered perceptions, thinking and behaviors have a pervasive effect on personal, social and work functioning. Symptom types and severity vary by person. Schizophrenics may have trouble initiating and maintaining meaningful interpersonal relationships, fulfilling responsibilities and caring for themselves including personal grooming, hygiene and managing finances. They might miss work, withdraw socially and live in seclusion. In conversations, they may act paranoid, make bizarre comments or be hostile.
How to Cope with Schizophrenia? Learn the FactsFully developed early-onset schizophrenia consists of three symptom cluster types:
Positive symptoms. Delusions are false, unusual or exaggerated beliefs, perceptions or impressions. Hallucinations involve perceiving or sensing incorrectly that something is present. Thought process problems with illogical thinking and/or incoherent speech and behavior difficulties including bizarre, repetitive or ritualistic actions may be severe.
Negative symptoms. These reflect problems relating to others. They include lack of emotional expression, reduced speech or communication without obvious content, social withdrawal, lack of interest and difficulty concentrating or performing tasks.
Affective symptoms. Approximately 60 percent of schizophrenics suffer major depression during their illness and are at high risk for this psychiatric disorder in their older years. This is especially true when people have additional medical problems, take medications with depression side effects or have an alcohol or other substance abuse history.
How Late-Onset Schizophrenia Differs
Late-onset schizophrenics are more likely to be married women who functioned independently at near-normal levels until structural deficits in their brains broke down. They may have seemed eccentric with occasional paranoid thoughts and isolation, but they developed some satisfying relationships in earlier years. These are common causes.
Genetic factors. Schizophrenia’s heritability is about 80 percent. A first-degree relative increases your risk of developing this disorder by five to 10 times over the general population.
Dopamine and estrogen. Patients inherit problems associated with dopamine in the brain. This neurotransmitter is essential for the central nervous system to function normally. Studies show that estrogen regulates dopamine. Women tend to develop schizophrenia when their estrogen levels drop significantly in their late 40s, causing their dopamine to increase. Since men are less likely to become schizophrenic after 40, estrogen is the likely culprit.
Stress and illness. Late-onset schizophrenia may develop after a period of severe stress or physical illness.
Environmental stress. Schizophrenia may occur after transitional periods such as loss of children to adulthood, death of parents or peers, mid-life crises or retirement.
Middle-aged women are most likely to develop the paranoid schizophrenia subtype. Unlike early-onset schizophrenics, they don’t have severe cognitive deficits. Late-stage women experience many of the same positive symptoms as people diagnosed at younger ages. In particular:
Partition Delusions: Patients have a fear of others contaminating, spying on or capturing them. They believe disease, radiation, chemicals, people or spiritual entities can pass through walls and other physical barriers.
Persecutor Delusions: The chronic fear of persecution makes schizophrenics believe some entity wanting to harm them, usually fatally, is following, intercepting and constantly hunting them down.
Running Narrative Hallucinations: In response to their actions, patients hear chronic, running narratives that can be invasive and intolerable.
Third-Person Hallucinations: Schizophrenics experience stress while hearing voices badmouthing them in third person.
Accusatory Hallucinations: Voices accuse patients of being immoral, bad or sinful and may push them to atone for some behavior.
Doctors prescribe the appropriate medication(s) and determine the length of long-term treatment.
Estrogen. Findings suggest restoring estrogen to normal levels may protect menopausal women. An animal study concluded estrogen relieved schizophrenia in both male and female rats. It also found that low doses of estrogen increased anti-psychotic drug effectiveness.
Antipsychotics. Women respond to prescriptions like Geodon (Ziprasidone), Abilify (Aripiprazole), Risperpdal (Risperidone), Olanzapine and Quetiapine better than men. Based on your age, your doctor may prescribe a low dose.
Schizophrenia symptoms are less intense in later life, perhaps due to biological changes in the brain and better self-management. Minimize stress, avoid alcohol and other substance use, seek medical care as needed and take medications as prescribed to improve long-term functioning. Late-stage schizophrenics with family or social support tend to remain independent more successfully than early-onset patients.