Schizophrenia in people over 65

The term “late paraphrenia” is often used to describe the most common psychotic illness in people over 60 years of age.

Although relatively uncommon, the true incidence is not known.

In late paraphrenia, delusions are usually persecutory, but differ from schizophrenia in younger people in that they are more mundane. For example, the person is more likely to complain that the neighbours are trying to kill him or her, rather than alleging a plot by aliens. Hallucinations are also common. They are usually auditory, but tactile and olfactory hallucinations can occur. Visual hallucinations are rare.

Personality deterioration can occur, but less frequently than in schizophrenia in younger people.

Although late paraphrenia is the most common presentation of psychotic illness in people over 60, other presentations may include:

Paranoid schizophrenia with symptoms identical to those in younger people.

A mixed depressive and schizophrenic illness.

Paranoid states proceeding rapidly to dementia.

In late paraphrenia, between 50 and 75 percent of people have a full or partial response to antipsychotic medication. Although it is unusual for delusions to completely resolve, they are often reduced to a level where the person can function normally. People with late paraphrenia are often reluctant to commence treatment, and many require admission to hospital to start medication.

Schizoaffective disorder (an equal mixture of schizophrenia and mood disorder or schizophrenic illness followed by a mood disorder or vice versa) occurs in people over 65. The outcome is less favourable than for depressive illness. The treatment is the same as that for younger people.