Mohammed T. Abou-Saleh

LATE-LIFE PSYCHOTIC DISORDERS 495Table 89.1 Comparison of typical-onset (age 15–40) schizophrenia,middle-age-onset (age 41–65) schizophrenia, and very late-onset (age465) schizophrenia-like psychosisaffective blunting but more likely to have visual hallucinations26,34,37 and have less familial aggregation of schizophrenia 40 .It should be emphasized that the members of the InternationalLate-onset Schizophrenia Group were not unanimous in theirsupport of the particular age cut-offs given in the consensusstatement and also felt that the proposed nomenclature was not anend but a beginning of future research into this important topic.Late-onset schizoaffective disorder and late-onset delusionaldisorder are not specifically addressed in the consensus statement.Based on recent research 38 , late-onset schizoaffective disorderappears to share a majority of critical clinical and demographicfeatures with late-onset schizophrenia. Thus, late-onset schizoaffectivedisorder appears to be a subgroup of late-onsetschizophrenia in which mood symptoms are also present. Lateonsetdelusional disorder, by contrast, can be distinguished fromlate-onset schizophrenia by a unique preoccupation with nonbizarredelusions in the context of preserved affective andpersonality functioning in other domains 29 . In addition, treatmentof these individuals may be more challenging than in schizophreniadue to a difficulty in establishing rapport with therapists 39 .Cognitive function, however, is somewhat more preserved in olderpatients with delusional disorder than in those with schizophrenia39 . Unfortunately, there is a lack of research comparing earlyandlate-onset delusional disorder.Further research is needed to clarify the classification of lateonsetpsychotic disorders. Specifically, longitudinal follow-upstudies are necessary to determine whether the course of illness isdifferent in the three groups of patients and how the course oflate-onset disorders compares to that of early-onset syndromes.Such an enterprise is greatly aided by the consensus classificationrecently proposed. In summary, despite a tumultuous history, thefuture for research and clinical work in late-onset psychoticdisorders appears to be on firmer footing for the new millennium.ACKNOWLEDGEMENTSThis work was supported, in part, by the National Institute ofMental Health Grants MH43695, MH49671, MH45131 andMH19934 and by the Department of Veterans Affairs.REFERENCES15–40 41–65 465Female:male ratio 0.6:1 2:1 up to 8:1Poor premorbid functioning ++ + 7Family history of schizophrenia ++ ++ 7Sensory deficits 7 7 +Negative symptoms +++ ++ 7Thought disorder +++ +++ 7Strokes, tumors 7 7 +Neuroleptic dose +++ ++ ++, presence; 7, absence; number of symbols indicates degree of presence or absence.1. Berrios GE. Late-onset mental disorders: a conceptual history. InLate-Onset Mental Disorders: The Potsdam Conference. Bell & Bain,1999; 1–23.2. Howard R, Rabins PV, Seeman MV, Jeste DV and the InternationalLate-onset Schizophrenia Group. 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