Late-onset schizophrenia and very late-onset schizophrenia-like psychosis

Late-onset schizophrenia (LOS) and very late-onset schizophrenia-like psychosis (VLOSLP) have been a source of interest, confusion, and debate amongst psychiatrists for more than a hundred years. Recent consensus on cut-off ages for diagnosis, the availability of new research techniques, and the pressures of an ageing population have stimulated interest in this area. Although LOS and VLOSLP are subsumed under the general diagnosis of schizophrenia in ICD-10 and DSM-IV, clinicians generally agree that a distinct pattern of symptoms is present in patients who first develop schizophrenic illness in later life. Debate continues as to whether LOS and/or VLOSLP represent pathological entities distinct from early-onset adult schizophrenia. In terms of treatment, modification of pharmacological therapy, provision of physical health care, and social support are all important aspects of treating an older age group. This brief review describes the diagnostic criteria, summarizes current research into pathology, and provides information on management.