9 - Schizophrenia at the extremes of life

Summary

This chapter compares and contrasts the characteristics of patients presenting for the first time with a schizophrenia-like illness at the extremes of life. Unless otherwise stated, ‘childhood onset’ refers to illness onset in childhood (0-12 years) and ‘adolescent onset’ to onset roughly between ages 13 and 18 years (Werry, 1992). The term ‘early onset’ is used for both childhood- and adolescent-onset schizophrenia. Very-late-onset (or ‘late paraphrenia’) illness is taken as onset after the age of 60 years (Roth, 1955). The chapter details the epidemiology, gender differences, phenomenology, risk factors (including premorbid functioning), outcome and treatment for early- and very-late-onset schizophrenia in turn, pointing up areas of similarity as well as important differences in these domains. This is summarized in Tables 9.1 and 9.2. In the concluding section, we address the issue of whether the similarities outweigh the differences, how far the differences can be considered merely a reflection of the same illness impinging upon the individual at different developmental/degenerative phases of life, and to what extent the differences might point to early- and very-late-onset illnesses being, in fact, discrete entities.

Methodological concerns

Research into the prevalence and incidence of schizophrenia in early life has been infrequent and often incomplete. This is a consequence, in part, of the rarity of the disorder, particularly in childhood.