Late-Onset Schizophrenia: Symptoms, Diagnosis, And Treatment

Schizophrenia is a mental illness that usually involves psychotic symptoms. People who have the disorder often experience distress related to hallucinations, delusions, and disordered thoughts and behavior. Most commonly, people develop schizophrenia in their late teens or twenties. However, some people develop late-onset schizophrenia (between ages 40 and 60) or even very late-onset schizophrenia (after age 60). Late-onset schizophrenia seems to be more common in women, and those with this disorder tend to require lower antipsychotic doses and may be more sensitive to medication side effects. Additional treatments, such as therapy and psychosocial interventions, can be especially beneficial for individuals with late-onset schizophrenia.

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What is late-onset schizophrenia?

"Late-onset schizophrenia" can describe instances of the mental health disorder schizophrenia that begin when a person is between 40 and 60 years old. Some people also call late-onset schizophrenia "LSO" or "latent schizophrenia." Very little research has been conducted on individuals with latent or late-onset schizophrenia, but more information has been uncovered in recent years.  

Are late-onset and early-onset schizophrenia the same?

When a person develops schizophrenia between the ages of 13 and 18, they are usually said to have early-onset schizophrenia. Meanwhile, schizophrenia that develops during the early adult years can simply be referred to as schizophrenia. Experts are divided on whether the age of onset could indicate the presence of different disorders or if schizophrenia is the same regardless of when the condition develops.

For many years, experts assumed that schizophrenia always began in early adulthood. At one point, the presence of symptoms prior to age 45 was required for a person to receive a schizophrenia diagnosis. People assumed that older individuals who developed schizophrenia-like symptoms later in life had a different disorder, like dementia or other form of neurodegeneration. Later, the requirement to develop symptoms before age 45 was dropped from the schizophrenia diagnostic criteria.

Late-onset schizophrenia: Understanding differences and diagnostic challenges

Experts aren't sure if late-onset schizophrenia involves the same internal mechanisms as early-onset schizophrenia or if this involves a different process. Schizophrenia is sometimes thought of as a neurodevelopmental disorder, which may mean that the condition occurs because of problems that occur as a person develops. However, because a person with late-onset schizophrenia doesn't experience mental illness until middle age, some experts think it's unlikely that the disorder has to do with development. 

Exploring the link between late-onset and typical-onset schizophrenia

Others think that late-onset and typical-onset schizophrenia could be the same disorder. These experts typically believe that, in late-onset schizophrenia, neurological changes begin to happen at a young age, but clinical symptoms don't appear until middle age. Those with this opinion are usually more likely to call the disorder “latent schizophrenia.”

When an older adult experiences psychosis, their healthcare providers generally must search for other possible causes before landing on a diagnosis of late-onset schizophrenia. About 60% of older adults who have psychotic symptoms may be experiencing secondary psychosis, which means the symptoms have been triggered by another medical condition or medication.

Positive and negative symptoms of late-onset schizophrenia

Schizophrenia normally causes symptoms that can be categorized as either positive or negative. Positive symptoms can involve thinking, feeling, or acting in ways that are considered abnormal, such as hallucinating, experiencing delusions, or behaving in a way that is inappropriate for the situation at hand. Negative symptoms generally involve not thinking, feeling, or acting in ways that would be expected in a situation. For example, negative symptoms may include not experiencing emotions, not desiring social relationships, not speaking in social situations, or not making facial expressions or gestures normally used to indicate thoughts and feelings.

Some research suggests that people with late-onset schizophrenia tend to have less severe positive symptoms and more severe negative symptoms. This expression of symptoms can make late-onset schizophrenia more challenging to diagnose. However, some research has come to the opposite conclusion, suggesting that people with late-onset schizophrenia experience less severe negative symptoms than those who develop the disorder as young adults. More research is likely needed to understand the pattern of symptoms seen in late-onset schizophrenia.

What is very late-onset schizophrenia?

Very late-onset schizophrenia usually refers to schizophrenia that develops when a person is 60 years of age or older. Very late-onset schizophrenia is not its own diagnostic category in the DSM-5 — elderly people who have the disorder are typically just given the diagnosis of schizophrenia. Some experts also refer to very late-onset schizophrenia as “very late-onset-schizophrenia-like psychosis,” or VLOSLP.

The special circumstance of very late-onset schizophrenia

Most experts believe that very late-onset schizophrenia has symptoms with schizophrenia that develops during the young adult years, but it may involve different underlying mechanisms, like neurodegeneration. Others believe that very late-onset schizophrenia may be triggered by medical conditions or medications.

Prevalence of late-onset schizophrenia

The researcher who first studied late-onset schizophrenia estimated that about 15% of schizophrenia patients experience a late onset. More recent research estimates that 15% to 29% of people with schizophrenia may develop the disorder when they are 40 years old or older. More research may be needed to establish a more accurate estimate of how many people with schizophrenia develop the condition after age 40.

Risk factors for late-onset schizophrenia

Many of the risk factors for late-onset schizophrenia are the same as those for schizophrenia developed in the early adult years, which is why some experts believe they could be the same illness. 

Mental health risk factors for late-onset schizophrenia

• Family history: In general, about 10% to 15% of people with schizophrenia have a family history of schizophrenia or another psychotic illness. 
• Genetics: Some research has found that people with late-onset schizophrenia may be more likely to have a missing allele (part of a DNA molecule). Researchers think this missing allele may cause a person to experience an altered response to viral infections as an infant or in the womb. Being unable to clear infections may lead to neurological damage that causes schizophrenia later on.
• Gender: In general, women are more likely to develop late-onset schizophrenia. By contrast, typical-onset schizophrenia is thought to be experienced equally across genders. Some researchers have suggested that this may be due to changes in the X chromosome, but more research may be needed.
• Inflammation: Inflammation may be involved in the development of schizophrenia. Older adults generally have more inflammation than younger adults, so it's feasible that inflammation could play even more of a role in late-onset schizophrenia. This idea hasn't yet been confirmed by research, however.
• Cognitive impairments: People with both typical onset and late-onset schizophrenia often have cognitive impairments that precede their schizophrenia symptoms. They may fall behind their peers when processing information.
• Lower education: Lower education levels tend to be associated with schizophrenia at any age of onset. However, less education may be a result of the disorder’s development, rather than a risk factor that causes schizophrenia to develop. Lower education could reflect that people with schizophrenia often experience cognitive deficits before their schizophrenia symptoms appear.

Mental health treatment for late-onset schizophrenia

At this time, the treatment plan for late-onset schizophrenia tends to be the same as the treatment plan for schizophrenia that develops during early adulthood. Often, people with schizophrenia are given prescription medications called antipsychotics, which must be prescribed and monitored by a doctor or psychiatrist. However, experts note that people with late-onset schizophrenia usually require lower antipsychotic doses than those who develop schizophrenia during their early adult years. People with late-onset schizophrenia may also experience more severe side effects when taking antipsychotics, which providers must keep in mind.

Treating comorbidities

If a person with schizophrenia has a mood disorder, like anxiety or depression, they may also take anti-anxiety medications or antidepressants. Researchers have pointed out that those with late-onset schizophrenia are usually more likely than their younger counterparts to have physical health problems that require treatment, such as heart attacks or chronic obstructive pulmonary disease (COPD). Treatment outcomes can be improved when providers properly identify and treat these comorbidities.

In addition to medication, people with schizophrenia often receive other treatments as part of a broader care plan. These treatments may involve one-on-one talk therapy, group therapy, support groups, work training, and communication training. Exercise programs can also be helpful, especially for older adults.

Remote therapy for late onset schizophrenia

Talk therapy is often used as part of a larger treatment plan for people with chronic schizophrenia and late-life schizophrenia. Therapy and other non-medication treatments may be particularly useful tools for people with late-onset schizophrenia, since older adults are generally more sensitive to medication and tend to experience side effects. 

Could you be living with schizophrenia?

Discuss your symptoms in online therapy

Remote therapy can provide a convenient option to those who might not be able to drive or would prefer to attend sessions from the comfort of their own homes. If you're interested in therapy for late-onset schizophrenia or any mental illness, BetterHelp can connect you with a qualified practitioner. However, please note that individuals experiencing crisis situations or acute psychotic symptoms may require in-person care.

Effectiveness of remote therapy for late-onset schizophrenia treatment

Research suggests that remote treatments could be viable options for people with schizophrenia. One study concluded that remote treatments could be particularly helpful for people with schizophrenia who struggle to attend in-person therapy sessions. Other research studies have found that remote treatment for schizophrenia may improve health outcomes. Since people with late-onset schizophrenia tend to have more physical illnesses, remote therapy may benefit them in this regard, although more research is needed.