Navigating Change: Does Schizophrenia Get Worse As You Age?
Schizophrenia is a chronic mental health condition that generally impacts less than 1% of the general population worldwide. Symptoms of schizophrenia can impact a person's cognitive function and overall mental health, which can affect their daily life at work and at home. For a person with schizophrenia, treatment may consist of a combination of medication and psychotherapy, which can reduce symptoms over time.
People with schizophrenia may experience changes as they age, and these changes can vary widely based on environmental and genetic factors. While the ways people experience schizophrenia may differ, there are some general guidelines and predictors to make effective treatment decisions. Working closely with your treatment team may help you maximize treatment efficacy and maintain a high quality of life.
What is schizophrenia?
Schizophrenia is a severe and chronic mental illness that usually affects how a person thinks, feels, and behaves. People with schizophrenia may lose touch with reality, which can be distressing for both the individual and those around them. Symptoms of schizophrenia can include positive symptoms, negative symptoms, and cognitive symptoms.
- Positive symptoms – Symptoms that occur in addition to normal function, such as hallucinations, delusions, and disorganized behavior
- Negative symptoms – Symptoms that can appear as an absence of normal behavior, such as social withdrawal, blunt affect, and reduced speech production
- Cognitive symptoms – Symptoms involving cognitive processing, such as reduced working memory, attention span, and executive function
These symptoms may occur differently in different people, and there can be a wide variety in how individuals with schizophrenia are impacted by their symptoms. Symptoms of schizophrenia can make it challenging to perform tasks at school or work and may negatively impact interpersonal relationships as well. Although symptoms may impact daily life, working with a mental health professional may reduce symptoms and provide a person with the tools they deserve to manage schizophrenia.
One of the challenges of managing schizophrenia may be that the disorder has been stigmatized. In general, one of the most pervasive myths about schizophrenia is that individuals with the disorder are violent or dangerous. In reality, the vast majority of people with schizophrenia are not violent, and they tend to be more likely to be the targets of violence than the perpetrators. In addition to violence, some people may view people with schizophrenia as being intellectually disabled or hopeless, neither of which is true. Overcoming these misconceptions can be an important part of seeking help and treatment.
What is the progression of schizophrenia?
How schizophrenia progresses in a person can depend on a variety of individual factors, including environmental factors and genetics. Early symptoms of schizophrenia may be subtle and hard to notice. This phase is often called the prodromal period, and symptoms can include odd thought patterns, social isolation, and reduced speech. For some, the first time they realize they are experiencing symptoms can be after a psychotic episode.
The prodromal period can last for weeks, months, or years. The subclinical prodromal period usually ends when symptoms become severe enough to warrant a diagnosis of schizophrenia by a licensed mental health professional. This usually occurs after an acute psychotic episode or another major symptom.
Once a person has been formally diagnosed, they may be treated with antipsychotic medications to manage symptoms. These medications must be prescribed and carefully monitored by a doctor or psychiatrist. Over time, a person may cycle between periods of remission and active schizophrenia.
When a diagnosis is given before age 18, it is generally considered early-onset schizophrenia. Individuals with early-onset schizophrenia may be impacted differently than adults due to neuronal changes that occur during adolescence. This may impact cognitive decline more profoundly in youth than in adults.
For people who receive a diagnosis over age 45, the disorder is usually considered late-onset schizophrenia. Older individuals may experience fewer positive symptoms and more negative symptoms overall, although updated research may be needed.
How does schizophrenia change with age?
Although some symptoms may change or worsen with age, how schizophrenia progresses may primarily depend on environmental factors and treatment. Common challenges faced by older adults with schizophrenia may include the long-term effects of antipsychotic medication, changes in symptom presentation, and comorbid disorders or diseases that can impact physical health.
As a person ages, aspects of cognitive and physical health may deteriorate, even without having schizophrenia. For individuals with schizophrenia, older research suggests that certain disorders and diseases may increase as a result of side effects from medication, including a potential increase in obesity and heart disease.
As a person ages, it can be important for them to discuss symptoms and side effect changes with their doctor or mental health professional. These professionals can help individuals develop a long-term treatment plan that focuses on maximizing quality of life and maintaining functionality.
Quality of life and functional outcomes
As a person ages, living with schizophrenia can impact quality of life in a few ways. Aging with schizophrenia may come with comorbid physical and mental health concerns, including obesity and heart disease. These challenges can make it difficult for individuals with schizophrenia to maintain good overall health over time. Although quality of life may be impacted by schizophrenia, it can be possible to reduce these impacts by working with a team of professionals to manage symptoms and actively maintaining healthy habits.
Another concern related to quality of life can stem from higher rates of unemployment among individuals with schizophrenia. Maintaining a job or career while experiencing symptoms of schizophrenia, especially positive symptoms, can be challenging. These symptoms can make a person less productive and may inhibit communication, which can prevent a person from doing their job well. Unemployment can make it challenging for a person with schizophrenia to pay for daily needs or housing.
Getting support for schizophrenia and improving quality of life may be a team effort. Individuals with schizophrenia can often benefit from working with a large support network that includes friends, family, mental health professionals, doctors, and career counselors. These experts can provide guidance and support during challenging times and develop a plan to improve the individual’s quality of life.
Treating schizophrenia
Treating schizophrenia often requires a multidisciplinary approach that involves various mental health professionals, along with doctors or other support personnel. In many cases, diagnosis occurs after a period of active schizophrenia that may include psychosis or hallucinations. In most cases, one of the first treatments offered is antipsychotic prescription medication.
These medications can reduce the incidence of psychosis and contribute to overall stability. For older individuals, doctors may weigh the benefits against side effects to ensure that the medication is still working to their benefit.
In addition to medication, it may be advised that a person with schizophrenia also work with a therapist and partake in psychotherapy or psychosocial interventions. These interventions may be given in an in-person or virtual environment.
Studies on the impact of online therapy for schizophrenia show that online cognitive behavioral therapy (CBT) may be an effective way to manage symptoms of schizophrenia. In an online environment, a therapist can help an individual identify triggering thoughts or environmental triggers and develop a plan for reframing those triggers to potentially prevent positive symptoms.
For individuals with schizophrenia, finding a specialist or therapist who meets your needs within your local area can be challenging. However, with online therapy options, a person usually has more flexibility when it comes to finding a therapist who is a good fit. Online therapy sessions can be completed anywhere with an internet connection, and the therapist does not need to live near their clients. This may increase the likelihood of a person attending scheduled sessions, which can improve overall outcomes. Please note that in-person care may be required for individuals currently experiencing acute psychosis.
Takeaway
Growing older with schizophrenia can mean changes in symptoms and overall quality of life. For individuals with schizophrenia, it may be important to track symptoms and how they change over time so that a doctor or mental health professional can adjust treatment methods accordingly. These changes may include adjusting a prescription to manage side effects or changing therapy techniques to enhance overall well-being. Although the symptoms of schizophrenia may seem overwhelming, working with a mental health professional in person or online can help you manage them effectively.
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