Late-Onset Schizophrenia and Very-Late-Onset Schizophrenia-Like Psychosis: An International Consensus

Howard, Robert; Rabins, Peter V.; Seeman, Mary V.; Jeste, Dilip V.

doi:10.1176/appi.ajp.157.2.172

Cited by 592 publications

(475 citation statements)

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“…Because numerous studies have shown that the onset of schizophrenia tends to be later in life in women than in men (Howard et al, 2000), and the present results indicate that the separation between women with schizophrenia and HC women might differ from that between men with schizophrenia and HC men at various ages, understanding the effects of aging in schizophrenia will likely require studying LTL (and other aging parameters) separately in men and women (Ramsey et al, 2013).…”

Section: Discussionmentioning

confidence: 76%

Leukocyte telomere length: Effects of schizophrenia, age, and gender

Wolkowitz

Jeste

Martin

et al. 2017

Journal of Psychiatric Research

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a b s t r a c tBackground: Schizophrenia is linked with early medical comorbidity and mortality. These observations indicate possible "accelerated biological aging" in schizophrenia, although prior findings are mixed, and few such studies have examined the role of gender. One putative marker of biological aging is leukocyte telomere length (LTL), which typically shortens with age. Methods: We assessed LTL in phenotypically well characterized 134 individuals with schizophrenia (60 women and 74 men) and 123 healthy comparison subjects (HCs) (66 women and 57 men), aged 26 to 65 years. Results: Overall, LTL was inversely associated with age (t(249) ¼ -6.2, p < 0.001), and a gender effect on the rate of LTL decrease with age was found (t(249) ¼ 2.20, p ¼ 0.029), with men declining more rapidly than women. No significant overall effect of diagnosis on the rate of decline was detected. However, at the average sample age (48 years), there was a significant gender effect in both schizophrenia and HC groups (t(249) ¼ 2.48, p ¼ 0.014), with women having longer LTL than men, and a significant gender X diagnosis effect (t(249) ¼ 2.43, p ¼ 0.016) -at the average sample age, women with schizophrenia had shorter LTL than HC women. Discussion: Gender, not the diagnosis of schizophrenia, was the major factor involved with LTL shortening across the age range studied. We discuss the constraints of a cross-sectional design and other methodological issues, and indicate future directions. Understanding the impact of schizophrenia on biological aging will require separate evaluations in men and women.Published by Elsevier Ltd.

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Section: Discussionmentioning

confidence: 76%

Leukocyte telomere length: Effects of schizophrenia, age, and gender

Wolkowitz

Jeste

Martin

et al. 2017

Journal of Psychiatric Research

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“…Tomando por base o consenso internacional sobre esquizofrenia de início tardio (Howard et al, 2000), os diagnósticos mais plausíveis para os casos 1 e 2 são a esquizofrenia de início tardio (late-onset schizophrenia) e a psicose esquizofreniforme de início mais tardio (very late-onset schizophrenia-like psychoses), respectivamente.…”

Section: Discussionunclassified

“…Os dois casos clínicos evidenciam alguns fatores de risco citados na literatura a respeito dos diagnós-ticos citados, como a presença de isolamento social prévio (Henderson e Kay, 1997) e o sexo feminino (Almeida et al, 1995a;Barclay e Almeida, 2000;Brodaty et al, 1999;Holden, 1987;Howard et al, 2000;Silveira et al, 2004). No caso 2, podemos observar outro fator de risco para a patologia, o déficit auditivo (Almeida et al, 1995a).…”

Section: Discussionunclassified

“…No estudo da sintomatologia psicótica (PANSS), o caso 1 tem maior pontuação dos sintomas positivos, enquanto o caso 2 apresenta uma maior pontuação na escala negativa. Na psicose funcional com início após os 60 anos, sobressai a raridade de alteração formal do pensamento e de sintomas negativos (Howard et al, 2000), como está evidenciado no caso 2. Sintomas extrapiramidais são comuns em esquizofrênicos pelo uso de medicação antipsicótica.…”

Section: Discussionunclassified

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A evolução de longo prazo pode diferenciar dois subtipos de psicose de início tardio

Gomes¹,

Laks²

2005

Rev. psiquiatr. clín.

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ResumoA esquizofrenia de início tardio ainda é pouco estudada. Os trabalhos atuais apontam para uma patologia heterogênea, com perfil cognitivo semelhante ao encontrado na esquizofrenia com início no adulto jovem e dois tipos de evolução: um grupo com estabilização dos déficits neuropsicológicos e outro grupo com piora destes déficits ao longo do tempo. Apresentam-se dois casos clínicos avaliados por testes neuropsicológicos CAMCOG e Miniexame do Estado Mental (MEEM), Escore Isquêmico de Hachinski, Questionário de Atividades Funcionais de Pfeffer, PANSS e Inventário Neuropsiquiátrico. O desempenho cognitivo e das atividades de vida diária destes casos foram distintos, o que a p o n t a p a r a a n e c e s s i d a d e d e e s t u d o s p r o s p e c t i v o s c o m e n f o q u e neuropsicológico, para entendimento dos diferentes tipos de evolução das psicoses de início tardio.Palavras-chave: Esquizofrenia, idoso, diagnóstico. AbstractThere are few studies about late-onset schizophrenia (LOS). LOS is thought to be a heterogeneous pathology with a similar cognitive profile compared to adult schizophrenia and two types of evolution: one group with steady neuropsychological deficits and another group with progressive deficits. We report on two clinical cases evaluated with neuropsychological tests CAMCOG and MMSE, Hachinski's Ischemic Score, Pfeffer Functional Activities Questionnaire, PANSS and the Neuropsychiatric Inventory. The course of cognitive deficits and daily life activities were different, showing the need of prospective studies with neuropsychological approach to understand the clinical course and etiology of LOS.

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“…early-onset schizophrenia, EOS) je shizofrenija z začetkom v ali pred 40. letom starosti. Nekateri avtorji uporabljajo tudi starostno mejo 45 ali 50 let (1,(4)(5)(6)(7). Pozno nastala shizofrenija (angl.…”

Section: Definicijeunclassified

Shizofrenija z začetkom v poznem življenjskem obdobju

2018

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IzvlečekPozno nastala shizofrenija je v zadnjih letih predmet kontroverzne razprave v medicinski stroki predvsem zaradi težave pri doseganju konsenza glede postavitve same diagnoze. V članku skušamo na enem mestu pregledno povzeti znanstvene vire, nastale v preteklih desetletjih, in podati celostni pregled od diagnoze do zdravljenja te dokaj pogoste bolezni. Od zgodaj nastale shizofrenije se pozno nastala razlikuje po simptomih, zdravljenju, napovedi izida ter patogenezi, v kateri naj bi pri zgodaj nastali prevladovala motnja v razvoju, medtem ko gre pri pozno nastali po vsej verjetnosti za degenerativen proces znotraj centralnega živčnega sistema. Posebna pozornost pa je potrebna pri diferencialnodiagnostični obravnavi bolnikov, pri katerih sumimo, da gre za to bolezen. Izključiti je namreč potrebno degenerativne bolezni, ekspanzivne procese, nevrološke in psihiatrične motnje ter nazadnje tudi zlorabo psihoaktivnih snovi. V zadnjem času je veliko raziskav tudi s področja vloge genetike v patogenezi bolezni, vendar pa je poznavanje genetskega vpliva za klinično diagnostiko v tem trenutku še nezadostno. Zlati standard pri diagnosticiranju pozno nastale shizofrenije tako še naprej ostaja klinični pregled bolnika. Za konec pa smo poudarili tudi posebnosti farmakoterapije ter povzeli aktualne smernice zdravljenja pozno nastale shizofrenije. AbstractIn recent years, late-onset schizophrenia is a subject of controversial debate in the medical profession largely due to difficulties in reaching a consensus on the diagnosis of the disorder. In the present article we try to summarize in one place the scientific resources that were studying this disorder in the past decades and present a comprehensive overview from diagnosis to treatment of this relatively common disorder. Late-onset schizophrenia differs from early-onset schizophrenia in terms of symptoms, treatment, prognosis and pathogenesis, which is in early-onset schizophrenia based mainly on the developmental causes, whereas late-onset schizophrenia is most likely the result of a degenerative process within the central nervous system. Differential diagnosis of this disorder can be especially challenging and therefore demands additional attention. It is necessary to exclude degenerative diseases, expansive processes, neurological and psychiatric disorders, and ultimately, the abuse of psychoactive substances. Lately, there has been a lot of research done on genetic causes that could explain pathogenesis of the disorder, however, knowledge of the genetic influence for the establishment of clinical diagnosis is at this moment still inadequate. Thus, a clinical examination of the patient still remains the gold standard for the diagnosis of late-onset schizophrenia.. Finally, we highlight the particularities of pharmacotherapy and summarize the current treatment guidelines for late-onset schizophrenia.

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Late-Onset Schizophrenia and Very-Late-Onset Schizophrenia-Like Psychosis: An International Consensus

Cited by 592 publications

References 99 publications

Leukocyte telomere length: Effects of schizophrenia, age, and gender

Leukocyte telomere length: Effects of schizophrenia, age, and gender

A evolução de longo prazo pode diferenciar dois subtipos de psicose de início tardio

Shizofrenija z začetkom v poznem življenjskem obdobju

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