Clinical and Psychopathological Features of Late-Onset Schizophrenia and Schizophrenia-Like Psychosis

Abstract

   Background: schizophrenia-like psychosis with very late onset is one of the most common diagnostic group in late age mental disorders exclude dementia and depression with psychotic symptoms [1]. Geriatric psychiatrists discuss its similarity to neurodegenerative diseases and risk of dementia development in the outcome of disease.   The aim was to study the clinical and psychopathological features of very late manifesting schizophrenia and schizophrenia-like psychoses and their impact on the course of the disease.   Patients and methods: 45 patients were observed, the mean age was 70.6 ± 8.70 years. Patients were diagnosed with schizophrenia, schizoaffective disorder, chronic delusional disorder and schizophrenia-like disorder, with onset after 60 years. Psychopathological and psychometric (PANSS, CDSS, HAMD, MoCA, MMSE) methods were used. Assessment was performed at the 0 day and at the 28th day from the beginning of the treatment.   Results: heterogeneity and different short-terms outcomes of acute psychosis were described depending on the clinical characteristics and predominant syndrome complex. In 15 cases (33 %) prevailed severe polymorphic psychotic symptoms of mental disorganization with formation of negative symptoms and cognitive impairment with decreasing social and daily activity. In 22 cases (49 %) dominated paranoid symptoms with old age persecutory delusions with formation of residual positive and negative symptoms. In 8 cases (18 %) prevailed affective and delusional symptoms. This group was characterized with high level of reduction of productive symptoms and restoration of premorbid social and daily activity.   Conclusions: features of clinical characteristics, including the nature and severity of cognitive impairment at the onset of disease, are significant for prognosis and outcomes of disease. The data obtained could be served for the development of personalized therapeutic approaches that take into account the syndromic features and course of late-onset psychosis.