Can You Develop Schizophrenia Later In Life? Understanding Late-Onset Schizophrenia
Schizophrenia is a disorder that can affect people’s thoughts and behaviors. It usually starts in young adulthood, but this may not always be the case. Some people may start having symptoms earlier, while others may not notice them until later. When individuals develop schizophrenia after age 40, it’s usually referred to as “late-onset schizophrenia.” Meanwhile, schizophrenia that arises after age 60 is typically called “very late-onset schizophrenia-like psychosis.” Schizophrenia symptoms can generally be managed with the proper professional support.
An overview of schizophrenia
Schizophrenia is a serious mental illness that can change the ways people think, feel, and act. Schizophrenic patients may have trouble telling what's real and what's not. This is usually known as "psychosis," a state of being detached from reality. People with schizophrenia may also notice changes in their thoughts and mental abilities.
Scientists are still trying to figure out exactly what causes schizophrenia. So far, they've identified several possible risk factors:
- Having a relative with schizophrenia
- Being born at a low weight
- Being born in the winter
- Living in an urban area
That said, not everyone who is at risk of schizophrenia will go on to develop it. It’s likely to be triggered by a combination of factors, including environment, genetics, and life experiences.
The onset of symptoms in men and women
What are the positive and the negative symptoms of schizophrenia?
In general, there are two broad types of schizophrenia symptoms: positive and negative. These terms don't necessarily mean "good" and "bad." Rather, they can refer to experiences that are either present or absent in people with schizophrenia.
Positive symptoms may include the following:
- Hallucinating (seeing, hearing, or feeling things that aren’t real)
- Having delusions (false beliefs that can’t be changed)
- Rambling, mixing up words, or talking in unusual ways
- Moving in unusual ways
Negative symptoms may include the following:
- Losing motivation to do daily tasks
- Having trouble feeling pleasure
- Losing interest in being around other people
- Not expressing emotions
However, not everyone with schizophrenia may experience the same symptoms. For this reason, it’s listed as a “spectrum disorder” in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Late-onset schizophrenia: Can you develop schizophrenia later in life?
As we’ve discussed, schizophrenia usually starts during the early adult years. That said, this isn't always the case. Some people may start having symptoms outside the typical age range. Let’s take a look at a few other periods when this can happen.
Childhood-onset schizophrenia
Before age 13: Developing schizophrenia before age 13 can be considered rare. Some estimates suggest it happens at a rate of less than .04%. This is generally known as “childhood-onset schizophrenia.”
Children with schizophrenia may experience developmental delays before their symptoms start. They may also struggle to make friends and may have trouble with mood and behavior.
Early-onset schizophrenia
Before age 18: Developing schizophrenia before age 18 may be more common than before age 13. This is sometimes called “early-onset schizophrenia," and it often looks similar to typical schizophrenia. Early warning signs of schizophrenia in teens may include academic issues, unusual behaviors, and social isolation.
Late-onset schizophrenia
After age 40: Around 20% of people with schizophrenia develop it after age 40. This is usually known as “late-onset schizophrenia.” Late-onset schizophrenia tends to be more common in women than in men.
Scientists think this may be due to estrogen, a hormone that may protect the brain from schizophrenia. Women’s bodies normally produce less estrogen with age, which may make them more vulnerable to schizophrenia later in life.
After age 60: Some people may start having psychotic symptoms after age 60. This is typically known as “very late-onset schizophrenia-like psychosis.” You may notice that this diagnosis uses the phrase “schizophrenia-like” rather than “schizophrenia.” This may be because scientists believe that after age 60, psychotic symptoms are likely due to conditions other than schizophrenia.
Dementia, which often affects older adults, can serve as one example. Dementia may cause symptoms similar to schizophrenia, like delusions and hallucinations.
As you can see, schizophrenia may not always start at the same age for everyone. But how does age of onset affect the outlook for schizophrenia patients? In a 2017 review, researchers analyzed 81 studies to try to answer this question. They found that an older age of schizophrenia onset was usually associated with the following:
- Fewer hospitalizations
- Fewer negative symptoms
- Better social functioning
- Better work functioning
- Better overall outcomes
Future studies may uncover more insights about how age affects people’s experiences and long-term outlooks with schizophrenia.
Options for treating typical, early, or late onset schizophrenia
Whether you have typical, early, or late-onset schizophrenia, it can still be challenging. Chronic schizophrenia may contribute to issues at work and in relationships. People with schizophrenia may also be at a higher risk of conditions like depression and anxiety.
That said, schizophrenia is often manageable. At least one in three people may fully recover from their symptoms with the right treatment, which usually involves the interventions discussed below.
Community support to improve daily functioning
Community resources may help people with schizophrenia live independently and improve their daily functioning. Some examples can include the following:
- Job placement and training programs
- Housing assistance
- Schizophrenia support groups
- Educational programs
- Social skills training
Lifestyle changes to improve mental health
While not a replacement for professional treatment, certain daily habits like those listed below may support brain health and general well-being.
- Getting regular exercise
- Avoiding substances that affect the brain, like alcohol and other substances
- Managing stress
- Establishing healthy routines
- Socializing with friends and loved ones
Drug treatment
Medications are often a first-line treatment for schizophrenia. Your doctor or psychiatrist may suggest the following options:
- Antipsychotics, which may reduce hallucinations and delusions
- Antidepressants, which may help improve negative symptoms
- Mood stabilizers, which may make emotions more manageable
Therapy to support mental health with late onset schizophrenia
While medications may directly reduce symptoms in people with schizophrenia, counseling can support mental health in the long term. With therapy, it may be possible to improve thought patterns, learn healthy coping strategies, and more. Therapy can also be helpful for managing other mental illnesses besides schizophrenia.
Sticking to therapy may be easier if you have a good relationship with your therapist. That said, finding a counselor with whom you connect can sometimes take a few tries. Online therapy platforms like BetterHelp usually allow you to switch therapists whenever you want, for no additional charge. This may make it easier to find the right therapist for you.
Studies show that internet-based treatments may improve symptoms for people with schizophrenia. In 2016, researchers gave a telehealth program to a group of veterans with schizophrenia who were experiencing thoughts of suicide. Within three months, the majority experienced improvements in their symptoms.
If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.
Takeaway
How late can you become schizophrenic?
The clinical symptoms of schizophrenia are most frequently diagnosed in younger patients, typically teens and young adults. Symptom onset becomes less likely as a person ages, but in rare cases, schizophrenic disorders can appear much later in life. The terms “late-onset schizophrenia” (LOS) and “late-life schizophrenia” are typically used to refer to patients with a symptom onset age of between 40 and 60 years old.
Late-onset schizophrenia symptoms are similar to those observed in patients diagnosed at a younger age, commonly including hallucinations, delusions, odd behavior, disorganized speech, and negative symptoms like social withdrawal. However, research suggests that patients with LOS often require lower doses of antipsychotic medications and may experience fewer extrapyramidal symptoms, along with a reduced risk of developing tardive dyskinesia.
Researchers still debate whether LOS is the same condition as what is typically diagnosed in younger patients or whether it represents a sub-category of schizophrenia. Other mental disorders, including psychotic disorders other than schizophrenia, can cause similar symptoms and may become more challenging to differentiate as a patient grows older.
Beyond the age of 60, diagnosing schizophrenia becomes exceptionally challenging. Cognitive functioning tends to decline for everyone in old age, which can produce some symptoms similar to schizophrenia in elderly patients. The risk of dementias like Alzheimer’s disease and other neurodegenerative disorders rises considerably. Many disorders common in older patients can cause symptoms similar to schizophrenia and other psychotic disorders. Researchers have proposed the term “very-late-onset-schizophrenia-like-psychosis” (VLOSLP) to describe schizophrenia-like symptoms in those over 60 years of age.
Can you be schizophrenic without hallucinations?
Although auditory and visual hallucinations are common symptoms most patients with schizophrenia experience, they are not required to diagnose the condition. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, requires that two of the following five symptoms must be present for at least one month for a diagnosis:
- Delusions. Delusions are strange or unusual beliefs that are often inconsistent with reality.
- Hallucinations. Hallucinations are somatosensory disturbances that most often involve hearing things others cannot hear or seeing things others cannot see.
- Disorganized speech. The person might speak incoherently and be challenging to understand.
- Disorganized behavior and movement. The person might behave strangely or coordinate their actions similarly to those with movement disorders.
- Negative symptoms. Negative symptoms refer to the absence of traits or behaviors typically present, such as a lack of emotional expression, loss of enjoyment in previously enjoyed activities, and social withdrawal.
To be diagnosed with schizophrenia, at least one of two symptoms must be delusions, hallucinations, or disorganized speech. For instance, a patient could be diagnosed with schizophrenia if they only experience delusions and disorganized behavior but would not be diagnosed if their only symptoms are a lack of emotional expression and disorganized behavior. However, other psychiatric disorders could still explain their symptoms.
What is an example of schizophrenia speech?
According to the American Psychiatric Association, one of the main cognitive symptoms of schizophrenia is an inability to coordinate speech. A person with the condition might demonstrate speech that is sometimes referred to as “word salad.” It is often nonsensical and challenging for others to understand. Other mental disorders and neurodegenerative conditions like dementia can produce similar symptoms. The increased prevalence of disorganized speech among the geriatric population is one of the reasons diagnosing psychotic disorders in the elderly and treating older patients can be challenging.
How to calm down a schizophrenic episode?
Antipsychotic drugs administered under the supervision of a medical professional are typically the most effective way to reduce the symptoms associated with a psychotic episode. Patients experiencing their first episode are often medically stabilized by practitioners in hospital emergency departments, but previously diagnosed individuals may have access to medication that can address their symptoms.
The behavior of someone with untreated schizophrenia can be challenging to predict. If someone is experiencing a schizophrenia onset, it is typically most effective to help them receive medical attention. Those who are already receiving schizophrenia treatment may be aware of psychosocial interventions they learned as part of cognitive behavioral therapy or other psychotherapeutic interventions. It may be helpful to discuss the strategies and interventions the person relies upon while they are not experiencing a psychotic episode.
What are the warning signs of late-onset schizophrenia?
Clinical research published in the International Journal of Geriatric Psychiatry (often abbreviated as Int J Geriatr Psychiatry) indicates that late-onset schizophrenia (LOS) has nearly identical symptoms to early-onset schizophrenia (EOS). Therefore, the warning signs are similar for each. LOS is diagnosed in those between 40 and 60 years of age, which corresponds with a period of increasing risk for other disorders that can cause similar symptoms, such as early-onset dementia. If any of the following warning signs are noticed, it is likely worthwhile to see a medical professional for a comprehensive evaluation:
- Experiencing sights or sounds that feel strange or unreal. Hallucinations may begin as abstract shapes or noises rather than fully constructed images or voices.
- A decline in rational thought or holding beliefs inconsistent with reality.
- Disorganized or unintelligible speech.
- Shaking, tremors, or difficulty coordinating movement.
- A sudden reduction in emotional expression.
- Social withdrawal.
- Lack of enjoyment when engaging in preferred activities (anhedonia).
Other mental health conditions can cause some of the signs described above. For example, mood disorders, such as major depression, can cause social withdrawal and anhedonia, while conditions like schizoaffective disorder can substantially change how a person shows emotion. Similarly, bipolar disorder might cause significant shifts in behavior that are hard to explain. Schizophrenia, compared to many other mental health conditions, is likely to have a substantial adverse impact if left untreated, meaning professional evaluation is typically warranted even if symptoms are mild.
What can cause schizophrenia later in life?
The risk factors for late-onset schizophrenia (LOS) are similar to those for early-onset schizophrenia (EOS). However, researchers are still working to determine precisely what causes some people to develop symptoms while others do not. For EOS, genetics and family history are the most significant risk factors. Those with a family member who was diagnosed with schizophrenia are substantially more likely to develop the condition. Genetics likely play a more minor role in LOS, and later-life risk factors are more significant.
Researchers continue to investigate what can trigger schizophrenia later in life. There is some evidence to suggest that drug abuse and highly stressful life circumstances may increase the risk of developing the condition. Other factors, such as natural cognitive decline, certain medical conditions, traumatic brain injury, and other underlying conditions, may also play a role.
Do schizophrenics talk a lot?
Some people with schizophrenia demonstrate rapid and disorganized speech. It is a common symptom of the condition and is typically present during a psychotic episode. However, there is no evidence to suggest that people with schizophrenia are prone to excessive speech when their symptoms are well-managed.
What is schizophrenia like in real life?
The exact appearance and behavior of someone with schizophrenia can vary considerably from person to person. The presentation of schizophrenia worldwide is typically characterized by five main symptoms: delusions, hallucinations, disorganized speech, disorganized behavior, and negative symptoms. However, not all of the symptoms are required for diagnosis, and one person’s symptom profile may be very different from someone else’s.
If a person receives early intervention and treatment, they may be able to manage their symptoms to the point of effectively reversing the adverse effects of schizophrenia. However, those who are untreated or receiving insufficient treatment may experience a substantial negative impact on their well-being. Such patients often experience cognitive impairment that can make navigating work or school challenging. Schizophrenia can also make socializing difficult, which might further reduce quality of life by limiting social support. The lack of social support and coping skills might increase the risk of comorbid mood and anxiety disorders.
Schizophrenia is also associated with greater mortality than the general population. Those with the condition are at a higher risk of acute myocardial infarction (heart attack) and are significantly less likely to seek treatment for severe medical conditions. Those with schizophrenia are also at a higher risk of chronic bronchitis and chronic obstructive pulmonary disease (COPD).
How do people with schizophrenia act?
The behavior of those with schizophrenia can vary considerably from person to person, depending on the severity of their condition and their treatment approach. People who receive adequate treatment likely behave similarly to the general population. Those who are untreated or learning to manage their condition might behave oddly or in a manner that is difficult to understand. The cognitive deficits associated with a schizophrenic episode might make them say or do things they normally wouldn’t. It might also lead them to avoid things they usually do, such as hobbies or spending time with friends and family.
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