Can Schizophrenia Develop Later In Life

Common Causes Of Death

While issues related to psychosis may first come to mind with conditions like schizophrenia, the disorder can also take a physical toll. Physical diseases are linked to cause of death in about 60 percent of people with schizophrenia.

Cardiovascular disease is the top culprit. Studies estimate that this is the main cause of death in 40 to 50 percent of people with schizophrenia.

The elevated risk of cardiovascular disease in people with schizophrenia may be partly genetic, but its also largely affected by behavioral and lifestyle choices. People with schizophrenia are more likely to have certain lifestyle habits that increase the risk of cardiovascular disease, like smoking or a sedentary lifestyle.

Other physical or medical conditions known to increase the risk of death in people with schizophrenia include:

• visit a local emergency department
• reach out to a support group or emergency line

The National Suicide Prevention Lifeline is a 24-hour confidential service available by phone 7 days a week. This lifeline can connect you to crisis and emergency specialists for free. To learn more, call 800-273-TALK .

What Causes These Phases

Its unclear why individuals develop schizophrenia. Likewise, its unclear exactly how or why a person moves through the stages at the pace they do.

Researchers believe a combination of factors set off chemical and structural changes in the brain. Ultimately, these changes lead to schizophrenia. Those same factors may influence when or how quickly a person progresses from one phase to another.

Researchers believe these factors may contribute to developing schizophrenia:

• Genetics. If you have a family history of the illness, youre more likely to develop it. However, having a family history doesnt mean you certainly will have the illness.
• Hormonal changes. Researchers believe that hormones and physical changes in the body may be a factor. Symptoms of the illness often begin in young adulthood, during a time of major change. On average, men show first signs in their late teens and early 20s. Women develop the illness later. For them, symptoms typically first appear in their mid 20s to early 30s.
• Biological. Neurotransmitters relay signals between cells in the brain, and chemical changes may damage or impair them. This could lead to the illness.
• Structure. Changes to the shape or structure of the brain could interfere with communication between neurotransmitters and cells, too.
• Environmental. Researchers believe exposure to some viruses at an early age could lead to schizophrenia. Likewise, lifestyle choices may impact risk. These choices can include narcotic use or misuse.

Finding Mental Health Services

There are a few different options available for clinical treatment. Your choice will depend on cost, severity of your symptoms and convenience, but not all services are available everywhere. For people in rural and remote areas, treatment options can be reduced, involve long travel, or alternatively can be delivered through telehealth services. Ask your GP for advice about the best options available for you.

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Early Warning Signs Of Schizophrenia

Schizophrenia can be hard to diagnose for a few reasons. One is that people with the disorder often don’t realize they’re ill, so they’re unlikely to go to a doctor for help.Another issue is that many of the changes leading up to schizophrenia, called the prodrome, can mirror other normal life changes. For example, a teen who’s developing the illness might drop their group of friends and take up with new ones. They may also have trouble sleeping or suddenly start coming home with poor grades.

Some research suggests that if a doctor strongly thinks someone is getting the disorder while still in this early phase, low doses of antipsychotic medication might delay it. More studies need to be done to know whether these drugs work for young people at risk for the disease. Cognitive behavioral therapy, family therapy, and social skills training appear to have clearer benefits for them, at least in the short term, when used early on. Learn more about the prodrome phase of schizophrenia.

Why Positive And Negative Symptoms

Symptoms of schizophrenia can be referred to as positive or negative, but they dont mean good and bad.

Disordered thinking, hallucinations and delusions are called positive symptoms because they are something added to the persons normal experience. Low motivation and decreased pleasure are called negative because they take something away from a person’s experience.

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Planning For The Future

Relapse prevention plan

A relapse is when, after you recover from an episode of psychosis, your symptoms return and you experience another episode.

A relapse prevention plan is a powerful tool for staying well and avoiding a worsening of your mental health issue. Making a plan involves:

• identifying your triggers: what events or situations could set your symptoms off?
• identifying your warning signs: what changes in your thinking, emotions and behaviour signal the early signs of psychosis?
• planning responses: what will you do to cope or seek help when you experience triggers & warning signs?
• listing support people: who will you call when you experience triggers & warning signs?

Having a relapse prevention can make you and the people who care for you feel more secure, even if you never have to use it.

You can read more about relapse prevention plans at Orygen and Here to Help.

Advance care directives

Because of the way schizophrenia affects thinking, feeling and behaviour, if your symptoms worsen at some time in the future, you may not be able to make good decisions about your care. It can also be hard for the people around you to know whats best for you when the situation is intense and confusing.

An advance care directive is your instructions for what you want to happen if you cant make your own choices, and who you authorise to make decisions for you.

Diagnosing And Treating Late

The process of diagnosing schizophrenia can be complicated. Often, people use drugs or alcohol to cope with their untreated symptoms, and some of these substances can lead to temporary drug-induced psychosis that alters or worsens schizophrenia symptoms. Moreover, lack of information about schizophrenia makes many people with this condition unwilling to believe that they have it, which makes it harder for people to get help.

Unfortunately, there is no objective, biological way to tell if someone has schizophrenia. However, a health care provider can record and evaluate symptoms to make an informed diagnosis. This is especially easy if the symptoms are ongoing, which typically means lasting at least six months. However, six months of untreated schizophrenia is enough to derail someones life, so there is a clear need for early identification of symptoms and treatment.

Once a diagnosis has been acquired, schizophrenia treatment can begin. Each treatment plan will be different depending on the individual, but antipsychotic medications are often a cornerstone of treatment. These may be especially important for people with late-onset schizophrenia, since they are more likely to deal with psychotic symptoms like hallucinations and delusions.

Contact our Admissions staff at 300-8470 to discuss our treatment programs or reach out online.

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How Is Schizophrenia Diagnosed

There is no test available for schizophrenia. A doctor or mental health professional can do a mental health assessment in the form of a special interview. This includes questions about the current symptoms, past history of mental health issues, medical history, family history and any substance abuse issues. It is also helpful to speak to a family member for more information about the persons symptoms.

The doctor will then do a physical examination and may need to do blood tests or a brain scan to rule out any underlying causes. The diagnosis will usually need to be confirmed by a psychiatrist, who can advise on the best treatment options.

For a diagnosis of schizophrenia to be made, the symptoms need to be present for 6 months or more and be severe enough to cause problems in functioning at work, school, home or socially.

Sometimes a diagnosis of psychosis may be used instead of schizophrenia. This is a similar diagnosis but usually means the symptoms are less severe or have been present for a shorter period of time. Some people with psychosis go on to develop schizophrenia later in life but many recover completely.

When Schizophrenia Symptoms Start

Symptoms usually start to develop in early adulthood, between late adolescence and the early 30s. The disorder typically becomes evident slightly earlier in men than in women. Symptoms often emerge between late adolescence and the early 20s in men and between the early 20s and the early 30s in women.

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The Turning Point: Adolescence

An interaction between something in your genes and something in your environment probably causes the disease. Researchers still have a lot to learn about it, but it’s likely that many things play a role. Some, like exposure to a virus or malnutrition , might have happened while you were still in your mother’s womb. For vulnerable individuals, cannabis use can increase the risk of developing psychotic disorders such as schizophrenia.

No one knows exactly why it usually crops up in late adolescence, but there are many theories.

Your brain changes and develops a lot during puberty. These shifts might trigger the disease in people who are at risk for it.

Some scientists believe it has to do with development in an area of the brain called the frontal cortex. Others think it has to do with too many connections between nerve cells being eliminated as the brain matures.

Hormones also play a major role in puberty. One theory is that women get schizophrenia later than men because they go through puberty earlier and the hormone estrogen might somehow protect them. Know how to recognize the signs of schizophrenia in teens.

Outlines Of The Microglial Hypothesis Of Schizophrenia

Microglia, which account for about 10% of the total number of cells in the CNS, are derived from the mesoderm like blood and immune system cells and were thought to be monocyte-macrophage lineage cells. However, it has recently been reported that microglia originate from precursor cells generated in embryonic oval sac and they have a gene expression pattern different from those of bone marrow-derived monocytes and macrophages. As brain macrophages, microglia play a central role in the innate immunity of the CNS, and activated microglia are a major source of cytokines and free radicals. There is also the idea of conveniently dividing the direction of activation into tissue-damaging M1 and tissue-protecting M2. Inactivated microglia are called resting microglia, and their role has been unknown for a long time, but recent studies have revealed that they also play an important role in the development of the CNS and maintenance of homeostasis and are now called surveying microglia . The conceptual scheme of microglia in the pathophysiology of schizophrenia is as shown in Figure 1. At present, the pathophysiology of schizophrenia and the neuroinflammation or neuroimmune system centered on microglia. Regarding the abnormalities of neuroimmnune systems in schizophrenia, the following points are mainly mentioned :

Fig. 1.

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Consensus Statement Of The International Late

Schizophrenia, whether of early or late onset, from childhood to old age, is fundamentally heterogeneous and presumably consists of a group of related illnesses. In order to better understand the pathophysiology and etiology of the schizophrenias, to overcome difficulties associated with a lack of consistency in diagnostic criteria and nomenclature, and to develop multicenter studies of late-onset schizophrenia, an international consensus has been articulated with respect to specific definitions and current research questions. We believe that there is sufficient evidence to justify recognition of two illness classifications: late-onset schizophrenia and a very-late-onset schizophrenia-like psychosis.

The Age Of Onset In Men And Women

Its hard to pinpoint the exact onset of schizophrenia because people may have cognition problems or trouble in social relationships long before they are officially diagnosed. In general, schizophrenia is diagnosed in late adolescence through the early 30s.

Men are usually diagnosed between the late teens and early 20s, with a peak at 21-25 years of age. Women are diagnosed a few years later, at 25-30 or again after menopause.

The ages are just a guide. No matter when you notice any of the signs or symptoms of schizophrenia in yourself or a loved one, its important to get diagnosed and treated as soon as possible. Symptoms include confusion, disorganized speech, and hallucinations .

At Allied Psychiatry & Mental Health, board-certified psychiatrist Dr. Hadi Estakhri helps his patients live better quality lives through symptom management.

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Premorbid Cognitive And Scholastic Performance

Schizophrenia patients, when considered as a group, have intellectual impairments, some of which predate the onset of psychotic symptoms. Individuals who later develop schizophrenia have been found to perform below average on standardized measures of intelligence in childhood, adolescence and young adulthood, and to show lower premorbid IQ than the general population The lower the IQ, the higher is the risk for later development of schizophrenia.

Poor school performance can be seen as a premorbid sign. Repeating a grade, difficulties in completing the final level of schooling, and social and behavioural difficulties have also been found to be risk factors for developing schizophrenia. In the Northern Finland 1966 Birth Cohort, 14-year-olds who were below their expected normal grade were three times more likely to develop schizophrenia than those in their normal grade, but low school marks did not predict schizophrenia. Developmental continuity, indicated by early developmental deviation in the first year of life associated with lower school performance at age 16 years, has been found to be stronger among children who develop psychoses later in life than among normal controls and those admitted to hospital for non-psychotic psychiatric disorder.

Caring For Someone With Schizophrenia

Research has shown that involving family members in treatment for people with schizophrenia can help to reduce the likelihood of future episodes.

It helps to learn as much as you can about psychosis and schizophrenia. When youre well informed you have a better handle on what is happening and you can be more confident understanding and making decisions about treatment.

Stories from others caring for people with mental health issues are also a reminder that recovery is possible.

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The Case For Heterogeneity With Increased Onset Age

Schizophrenia-like psychoses, which cannot be attributed either to an affective disorder or focal or progressive structural brain abnormality, can arise at any time in the life cycle between childhood and old age. The expression of such psychotic symptoms shows greatest variation when onset age is at both extremes of life. Since the etiologies and the distinctive pathophysiologies of schizophrenia are at present unknown, variations in epidemiology, symptomatology, pathophysiology, and treatment response with age at onset can help to provide important clues to causative risk factors.

Epidemiology.

Female sex is associated with later age at onset. Incidence curves for men and women are different, and some preliminary data suggest three adult peaks that correspond to early adult life, middle age, and old age . Very-late-onset cases may arise in the context of sensory impairment and social isolation .

Symptomatology.

Pathophysiology.

Etiology.

Familial aggregation of schizophrenia is more common in earlier and middle-age onset than in very-late-onset cases . There is no satisfactory evidence that later age at onset of these disorders breeds true. Some studies suggest familial loading for affective disorders in patients with later-onset schizophrenia. The prevalence of a family history of Alzheimers disease, vascular dementia, dementia with Lewy bodies, or apolipoprotein E genotype is not higher in later-onset cases .

Historical Development Of Concepts

Studies of late-onset schizophrenia began with Manfred Bleuler , who personally examined 126 patients whose illness began after the age of 40 years. These late-onset cases constituted 15% of the schizophrenia patients he examined 4% of the patients had an onset after 60. About 50% of the patients with late-onset schizophrenia had symptoms that were indistinguishable from those seen in schizophrenic patients with the more typical younger age at onset. Bleulers age cutoff of 40 years influenced the German literature . Subsequent reports in the English literature used either 55 or 60 years of age as the dividing line and adopted the term late paraphrenia to both distinguish the illness from chronic schizophrenia and emphasize its clinical similarities with the condition described by Kraepelin . This was an unfortunate choice, however, since Kraepelin had never regarded late age at onset as a feature of paraphrenia. Moreover, the concept of paraphreniaexperiencing hallucinations and delusions without deterioration or disturbance of affective response, thus distinguishing the disorder from dementia praecoxhad been discredited . Driven by the early emergence in Europe of geriatric psychiatry as a distinct subspecialty, as well as the apparent syndromic coherence of late paraphrenia, including female preponderance , abnormal premorbid personality and social functioning , and deafness , the late paraphrenia concept was readily adopted and included in ICD-9.

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Medical Conditions In Older Persons With Schizophrenia

Until recently, a topic that has arguably received inadequate attention is comorbid medical conditions in people with schizophrenia, including adequacy of medical care and the prevalence of comorbid conditions. Medical comorbidity is even more pertinent to older persons with schizophrenia, given the increase in age-related disorders. A series of articles by Druss and colleagues compared the care that, patients with schizophrenia received after suffering a myocardial infarction with the care received by persons with no mental illness.37,38 Using the proportion of patients who undergo cardiac catheterization post-MI as a measure of quality of care they reported that, compared with patients with no mental illness, patients with schizophrenia were 60% less likely to undergo a cardiac catheterization after an MI.37 A second report found that these same patients had a 30% greater 1-year mortality than non-mentally ill patients. Approximately half of this increased mortality was due to a lack of quality medical treatment after the MI.38

Unrecognized or poorly managed comorbid medical illness is a significant source of excess disability and mortality in older persons with schizophrenia. The organization and delivery of care in a coordinated manner may be a challenge. All these are important directions for new research.