Late-Life Prognosis Varies In Early-Onset Schizophrenia

So there it is, the classical scenario—an adolescent hears “voices,” develops delusions about the voices, and starts acting abnormally. By young adulthood, he or she has developed schizophrenia.

But what happens to these young schizophrenia patients as they grow older? Some answers are provided by authorities on late-life schizophrenia. They came together at the Ninth International Congress on Schizophrenia Research, held in Colorado Springs, Colo.

Unfortunately, some early-onset schizophrenia patients do very poorly as the years go by, Philip Harvey, Ph.D., a professor of psychiatry at Mount Sinai School of Medicine in New York City and a late-life schizophrenia authority, reported. He used as an example a population of early-onset schizophrenia patients living in a psychiatric hospital on Long Island, many of whom have massive cognitive impairments. “These patients have lived there for 50 years,” he said, “because multiple attempts to deinstitutionalize them have failed.”

What’s more, cognitive decline has led to functional decline in many of these patients, Harvey pointed out, which, of course, also happens to Alzheimer’s patients. Still, only some 10 percent of these schizophrenia patients have Alzheimer’s, and the profile of cognitive deficits is quite different, Harvey said.

As other schizophrenia patients grow older, however, they do considerably better than the group that Harvey described. So reported Dilip Jeste, M.D., chair of aging and a professor of psychiatry at the University of California at San Diego. In fact, most older persons with early-onset schizophrenia live in the community, not in the hospital, Jeste stressed.

Research conducted by Jeste and his colleagues also underscores the more favorable outcome of this group of patients. They studied some 300 middle-aged and elderly persons who had early-onset schizophrenia and were living in the community. They assessed the subjects for positive and negative symptoms and found that they actually had fewer than a comparison group of early-onset schizophrenia subjects who were younger than the study group. The researchers also followed, over time, the cognitive abilities of the 300 older early-onset schizophrenia subjects and the cognitive abilities of a group of mentally healthy control subjects. They found no acceleration in cognitive decline in the schizophrenia subjects compared with the control group.

Like mathematician John Nash, a select few early-onset schizophrenia patients will eventually remit, Jeste reported. A pressing question, of course, is how many? No one is quite sure, he said, since reported rates of remission have ranged from as low as 3 percent to as high as 68 percent, depending on the population studied and the stringency of remission criteria.

In their own study of some 150 middle-aged or elderly early-onset schizophrenia subjects living in the community, Jeste and his colleagues found a remission rate of 8 percent using strict remission criteria. ▪