Developing Schizophrenia Before and After Adolescence
In the vast majority of cases, this brain disease does not become apparent until well into adolescence. At the other end of the age spectrum, it does not commonly appear in adults past age forty or so. When it does appear in an unusually young or old individual, one thing seems clear: it is similar to the disease that usually strikes young adults or adolescents. It is not clear what might accelerate or delay the appearance of symptoms in cases that develop in the very young or in those who are middle-aged.
It is extremely rare, but children as young as five can develop schizophrenia. In these unusual cases, the disease tends to follow a more chronic course with persistent symptoms and few if any periods of relief from them. It would be quite unusual, however, to detect psychotic symptoms such as hearing voices or other hallucinations or delusions in such very young children.
Although childhood schizophrenia appears to be similar to the disease that more commonly affects adolescents or young adults, it is often associated with other brain-related problems, including behavioral and learning problems, and neurological symptoms, including seizures and slight or mild mental retardation.
Some children may display indications that suggest they are not mentally healthy. These children often suffer from abnormal language development, and they may go on to develop schizophrenia or another mental disorder when they are in their teens, twenties, or early thirties.
Just as brain abnormalities have been detected in adults with schizophrenia, they have also been detected in children with the disease. Brain imaging studies reveal decreased gray matter in the cerebral cortex and decreased brain size, a feature that progresses with time.
Late Onset Schizophrenia
When schizophrenia first appears in an individual after the age of forty, it is called late onset schizophrenia. This sub-classification of the disease is distinguished from very-late-onset schizophrenia-like psychosis in which symptoms appear after age 60. Estimates of the number of cases developing after age 40 run as high as 10 percent to 23.5 percent of all schizophrenia cases.
It is possible that the late onset condition is the result of underlying pathologies distinct from the disease that strikes young people, but no one knows for sure. It has been suggested, however, that symptoms accompanying very-late-onset disease might be traced to the social isolation and impaired senses that can affect older people.
In 2000, a group of seventeen international specialists in the treatment of late onset schizophrenia published a consensus in the American Journal of Psychiatry. They agreed to the following points about schizophrenia when it strikes after age 40:
Some Features of Late Onset Schizophrenia and Very-Late-Onset Schizophrenia-like Psychosis
Women tend to show symptoms later than men.
There are more similarities than differences in early-and late-onset disease. This is particularly true for positive symptoms. However, visual, tactile, and olfactory hallucinations may be more common in late onset schizophrenia.
Cognitive deficits generally appear to be similar in early-and late-onset disease, but learning and the ability to abstract information may be less impaired with later onset disease. There is no evidence that dementia plays a role.
Negative symptoms and formal thought disorder are rare in very-late-onset schizophrenia-like psychosis.
Seniors affected by very-late-onset schizophrenia are less likely to have other family members affected by schizophrenia than are people with earlier and middle-age onset.
As with all forms of schizophrenia, treatment relies heavily on anti-psychotic drugs. A major difference in pharmaceutical therapy in late onset disease, however, is dose. Older individuals seem to be more sensitive to the effects of anti-psychotic medication and should initially receive much lower doses than young patients.
For most people affected by late onset disease, the dose might be only 25 percent to 50 percent of the dose a younger person would receive. And a person with very late onset disease might respond favorably to a dose just 10 percent of that given to a younger patient.