Exploring Late-Onset Schizophrenia Symptoms

Schizophrenia often starts early in life—but not always. Although most people develop the disorder during young adulthood, some people don’t develop schizophrenia until after age 40. This is usually referred to as “late-onset schizophrenia.” Individuals with late-onset schizophrenia may experience more intense hallucinations and delusions, but they may also require fewer hospitalizations and lower antipsychotic doses, although this can vary from person to person. Many people with schizophrenia can effectively manage their symptoms with the proper professional support, which often involves therapy and medication.

A closer look at schizophrenia

Schizophrenia is a mental illness that can change people’s perception, thinking, mood, and behavior. Schizophrenia is one of several psychotic disorders, which can be defined as disorders involving a break with reality or a “psychotic break.” 

Schizophrenia tends to be associated with changes in the brain itself. Research on people with schizophrenia has found differences in the frontal cortex, an area of the brain that contributes to thinking and social skills. 

People with schizophrenia may also have different levels of dopamine, a chemical that plays a role in motivation, pleasure, and movement. 

What makes a person develop schizophrenia in the first place? Scientists are still trying to find an exact cause. Genetics seem to be the biggest risk factor, but there may be others:

• Living in an urban environment
• Complications during pregnancy or childbirth
• Heavy use of cannabis
• Being born in the winter
  

A combination of environmental and social factors likely come together to trigger schizophrenia in people who are at risk. That said, overall, schizophrenia is fairly rare. According to the National Institute of Mental Health, the estimated rate of schizophrenia is less than 1%.

What is late-onset schizophrenia?

Schizophrenia usually develops in younger adults. In men, symptoms often start in the late teens to early 20s. In women, symptoms may start later, typically between the mid-20s and early 30s. However, symptoms don’t always appear during this window. Some people may develop schizophrenia before age 18. This is generally known as early-onset schizophrenia. But what about schizophrenia that starts later in life?

Around 20% of people with schizophrenia develop the condition after age 40. This is usually called “late-onset schizophrenia,” and it tends to be more common in women. This may be because the female sex hormone estrogen may have a protective effect against schizophrenia. 

When estrogen levels drop in middle age, this may trigger schizophrenia in some women who didn’t develop the condition sooner.

Understanding late-onset schizophrenia symptoms

Now that you’re familiar with the different age windows for schizophrenia, let’s take a closer look at its symptoms. These generally fall into three categories.

Positive symptoms: Positive symptoms can be thought of as experiences that are present in people with schizophrenia and absent in people without the disorder. Some examples can include the following:

• Hallucinations (seeing, hearing, tasting, smelling, or feeling stimuli that aren’t there)
• Delusions (false beliefs that can’t be changed with facts or logic)
• Scattered, unusual, or illogical thoughts
• Ways of speaking that others can’t understand

Negative symptoms: Negative symptoms can be defined as experiences that are absent in people with schizophrenia and present in people without the condition. Some examples can include those listed below:

• Not being able to experience pleasure
• Losing interest in other people
• Lacking motivation to do daily tasks (like bathing, going to work, or going out)
• Not showing emotions through voice, facial expressions, or hand gestures
  

Cognitive symptoms: Cognitive symptoms usually involve changes in people’s thinking abilities. People with schizophrenia may have trouble with certain types of mental tasks, such as:

• Remembering information
• Learning new things
• Thinking logically
• Making plans
• Paying attention
• Solving problems

Many people with schizophrenia show subtle changes in their thoughts and behaviors before their first psychotic episode. This period is usually known as the “prodrome” or “prodromal phase,” which it can last for months to years. 

How are regular- and late-onset schizophrenia different?

Late-onset schizophrenia tends to have similar symptoms as regular-onset schizophrenia, which can make it harder to diagnose. This is because schizophrenia symptoms often overlap with symptoms of other mental illnesses that often affect older adults. Dementia can serve as one example. Because dementia can also cause hallucinations, delusions, and changes in thinking, it’s not always obvious which one is affecting someone.

Some studies have found that schizophrenia symptoms can vary depending on when they start. According to a 2015 summary of recent research, people with late-onset schizophrenia may be more likely to have visual, auditory, and tactile hallucinations. They may also be more likely to cling to their delusions than people whose symptoms started when they were younger. However, people with late-onset schizophrenia may also be less likely to have negative symptoms, like a lack of pleasure or motivation.

Research has found that late-onset schizophrenia may have more positive outcomes. In a 2017 review of 81 studies, researchers found that people with late-onset schizophrenia usually had fewer hospitalizations than those who developed the disorder at a younger age. They also found that they typically had better social function and better function at work than their younger counterparts. 

In the 2015 research summary mentioned earlier, the authors also pointed out that late-onset schizophrenia tends to require a lower dose of antipsychotic medication.

Looking after your mental health with late-onset schizophrenia

No matter when the condition starts, schizophrenia can have significant effects on daily life. However, schizophrenia is often treatable with antipsychotic medications, social skills training, and other forms of mental health support. According to the World Health Organization, with proper schizophrenia treatment, at least one in three people may fully recover from their symptoms.

If you have concerns about late-onset schizophrenia, you may want to talk to your doctor. They may be able to advise you on medication and lifestyle changes to support your mental health. Your doctor may also recommend working with a therapist. Therapy can be a source of support, advice for managing symptoms, healthy coping strategies, and more.

Because people with schizophrenia may need ongoing support, in-person therapy may not always be a feasible option. Studies have found that in the U.S., as few as 11.3% of mental healthcare providers are “in-network” with people's insurance plans. This can make it hard to find affordable longer-term therapy. 

Online therapy may be an alternative, although it may not be appropriate for those experiencing acute psychosis. Platforms like BetterHelp generally offer professional therapy starting at $65 per week.

Studies have found that internet-based treatments may help people with schizophrenia. In a 2016 trial, a group of veterans with schizophrenia who were having thoughts of suicide were given a telehealth program for three months. The majority reported positive experiences and saw 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.