Schizophrenia in the Elderly: Robustness of the Essay

Schizophrenia in the Elderly: Robustness of the Research Literature

The American psychiatric community has historically ignored the presence of schizophrenia in older adults, especially the elderly, because many researchers and clinicians had attributed the etiology of the disease to organic causes such as dementia (Howard, Rabins, Seeman, & Jeste, 2000). A substantial body of European studies, however, have revealed that a small percentage of schizophrenia patients experience their first symptoms of psychosis after the age of 60 independent of organic causes. The lack of progress in this area has been attributed to the nomenclature assigned to the different schizophrenia age groups, which remains confusing, with some research groups designating first diagnoses after the age of 40 as late-onset, while others set the age boundary at 55 or 60-years of age. The naming of the disease has also been confusing, with early researchers, such as Kraepelin in 1919, calling the condition paraphrenia to distinguish it from psychosis caused by dementia.

These problems continue to the plague the research literature, which tends to make it difficult to conduct systematic literature reviews on schizophrenia in the elderly. However, a search of Medline using the string "literature review AND late-onset schizophrenia" retrieved 62 citations. This essay will examine a few recent reviews as a way to evaluate the current state of research in this area.

Reviewing the Reviews

An important milestone in late-onset schizophrenia research and care occurred after a group of researchers and clinicians met for two days in 1998 to try and provide an international consensus on the definition of late-onset schizophrenia (Howard, Rabins, Seeman, & Jeste, 2000).The International Late-Onset Schizophrenia Group agreed that schizophrenia, regardless of the age of onset, is a heterogeneous disease and is more properly referred to as 'schizophrenias' or schizophrenia spectrum disorder. They also agreed to distinguish between late-onset schizophrenia, with a cutoff of 40-years of age, with very-late-onset schizophrenia-like psychosis with a cutoff of 60-years of age.

Although the International Late-Onset Schizophrenia Group provided nomenclature help, they also agreed that research in this area is lagging due in part to past disagreements on symptomology, nomenclature, and etiology (Howard, Rabins, Seeman, & Jeste, 2000). They reviewed published studies on this topic and some epidemiological and treatment data was available to the group in 1998, but the quality and consistency of the findings were generally low. Their recommendations included future research in epidemiology, symptomology, pathophysiology, etiology, and treatment, because so little is known about this disease in aging adults.

More recently, a systematic review of late-onset schizophrenia in the elderly focused on the issue of antipsychotic….....