Background: Although the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders abandoned the use of the specifier 'late-onset', a considerable number of studies have reported clinical characteristics of late-onset schizophrenia. Still, only limited research has been conducted on late-onset schizophrenia, especially in Asian countries. In this epidemiological study, the clinical characteristics of late-onset schizophrenia were examined in comparison with early-onset schizophrenia. Methods: All patients with schizophrenia admitted to the psychiatric ward of Jichi Medical University Hospital between 1 April 1993 and 31 March 2006 were divided into two groups according to age at first onset: ≥40 years (late-onset group) and <40 years (early-onset group). The sex ratio, presence or absence of depression, schizophrenia subtype, premorbid character, marital history, and employment history at first onset were compared between the two groups. Results: Of the 316 patients with schizophrenia identified, 38 patients were assigned to the late-onset group and 278 patients to the early-onset group. Mean age at onset was 23.9 1 8.2 years for all men and 28.0 1 13.5 years for all women. The late-onset group was characterized by more women, more paranoid type, more depressive symptoms, less introverted premorbid character, better premorbid adaptation and less neuroleptics. Conclusion: The characteristics of late-onset schizophrenia in Japan are in line those reported previously.

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BackgroundGraves' disease is characterized by hyperthyroidism and the symptoms of Graves' disease often overlap with those of panic disorder, which may make it difficult to distinguish between the two conditions. In this report, we describe how proper diagnosis of thyroid disease in patients with mental illness can lead to appropriate treatment.Case presentationWe encountered a 34-year-old woman in whom thyroid crisis from Graves’ disease was misdiagnosed as panic attack. The patient was being managed as a case of panic disorder and bipolar disorder in a psychiatric outpatient setting. About 6 months before presentation, she had lost about 16 kg in weight, and a month before presentation, she developed several unpleasant symptoms as her condition worsened. Several weeks before, she had severe palpitations, tachycardia, and discomfort in her throat. She became unable to eat solids and ate only yogurt and gelatin and felt difficult to take psychiatric drugs.A day on the Sunday morning, she visited our department of emergency outpatient with severe nausea. Examination revealed proptosis, and so thyroid function tests were requested in addition to routine blood tests. There was no improvement in her condition, and she returned to hospital in the early hours of the next morning. Based on her symptoms, she was diagnosed as having panic attacks due to panic disorder and was given diazepam injection and allowed to go home. There was no suspicion of Graves' disease.Later that day, the thyroid function test results became available and thyroid storm was suspected. The endocrinology department was consulted immediately and she was referred and hospitalized the next day. During hospitalization, she was treated with steroid and radioisotope therapy, and was discharged from hospital in three weeks. ConclusionPsychiatrists and doctors engaged in psychosomatic medicine need to consider the possibility of thyroid disease as a differential diagnosis of panic disorder. It is necessary to check thyroid function at the initial examination when a patient presents with symptoms of severe panic attack.