Schizophrenia is a serious mental health condition that disrupts how a person thinks, feels, and behaves. Although typically diagnosed in early adulthood, schizophrenia can develop at any age. Recognizing the signs of late-onset schizophrenia can make a critical difference in getting a timely diagnosis and treatment for yourself or someone you care about.

What Is Late-Onset Schizophrenia?

When the symptoms of schizophrenia first appear at age 45 or older, it’s called late-onset schizophrenia. If the first episode occurs at age 60 or older, it’s called very-late-onset schizophrenia-like psychosis. Around 20 percent of new schizophrenia cases occur after the age of 40.

It’s More Common in Women

While early-onset schizophrenia is more common in men, late-onset schizophrenia occurs more frequently in women, according to the Indian Journal of Psychological Medicine. Some researchers believe the age-related drop in estrogen that many women experience may contribute to this difference. Researchers also think that since women tend to have stronger psychosocial support systems, like community connections and close relationships, this may help delay or reduce the severity of symptoms and delay the age of onset.

Around 20 percent of new schizophrenia cases occur after the age of 40.

The Symptoms May Be Less Severe

Signs may look different in people diagnosed later in life compared with those diagnosed in young adulthood. Some symptoms may be less severe. Mental health professionals call symptoms like delusions, hallucinations, and disorganized speech positive symptoms because they are added behaviors that aren’t normally present. People with a later onset of schizophrenia may also have fewer negative symptoms. These involve a loss of usual abilities, such as showing emotion, feeling motivated, or staying socially connected. Many can do well on lower doses of antipsychotic medication and may have a better long-term outlook with the condition.

Because late-onset schizophrenia symptoms can resemble those of age-related cognitive disorders or other mental health conditions, excluding other conditions to get an accurate diagnosis is a crucial first step toward effective treatment and improved quality of life.

Keep reading to learn about seven signs of late-onset schizophrenia. Please note that having some or all of these signs does not mean someone has the condition. A comprehensive medical and psychiatric evaluation is needed to confirm a diagnosis of schizophrenia at any age.

1. Paranoid Delusions

A person experiencing paranoid delusions may believe they are being harmed, harassed, or controlled, despite clear evidence to the contrary. They might think others are spying on them, plotting against them, or manipulating their thoughts, speech, or actions. In older adults, paranoid delusions may be mistaken for general mistrust or age-related memory issues, which can delay diagnosis.

2. Auditory Hallucinations

Hearing voices that aren’t there is an auditory hallucination. It’s a common symptom of schizophrenia and other psychotic disorders. People may also see things that don’t exist, a symptom of schizophrenia known as visual hallucinations. These experiences can be distressing, especially if the person doesn’t realize the voices or visions aren’t real.

3. Disorganized Thinking

Disorganized thinking can make a person’s thoughts feel jumbled or disconnected. This often shows up as disorganized speech, where the person may jump from one unrelated topic to another, speak incoherently, or respond in ways that don’t make sense. In conversations, they may struggle to stay on topic or logically express themselves.

4. Social Withdrawal

Social withdrawal refers to a reduced desire to interact with others. A person experiencing social withdrawal, or social isolation, may avoid friends and family, decline invitations, or lose interest in activities they once enjoyed doing with others. This shift in behavior may be more noticeable in people who were previously more outgoing and engaged with their friends and community. They may spend increasing amounts of time alone, avoid phone calls or visits, or appear emotionally distant.

5. Lack of Motivation

A lack of motivation, also called avolition, involves a noticeable decline in the drive to initiate or complete everyday tasks. This can include difficulty starting or completing chores, work, or personal goals. The person may struggle to get out of bed, prepare meals, or maintain basic responsibilities.

While a lack of motivation can appear as laziness or negligence before a diagnosis of schizophrenia is made, mental health professionals believe the lack of motivation in this case is a deeper issue tied to goal-setting, rewards, and action.

6. Changes in Personal Hygiene

Neglecting personal hygiene can be a warning sign of late-onset schizophrenia or other mental health conditions, such as depression, especially if this is a sudden change in routine or habits. Changes in personal hygiene may include a noticeable lack of interest in bathing, brushing teeth, changing clothes, combing hair, or doing laundry.

The person may seem indifferent to their appearance or not realize that they’ve stopped taking care of themselves like they used to. While one or two instances might not raise alarm bells, a new pattern of neglecting personal hygiene could be concerning.

7. Changes in Behavior

Unexplained changes in behavior or daily functioning can also be early signs of late-life schizophrenia. A person might begin acting in ways that seem unusual, inappropriate, or out of character for them. Changes may include sudden irritability or aggression, childlike actions, refusal to follow instructions, or unpredictable behavior in social situations. Over time, these behavioral changes can disrupt daily life and strain personal relationships. They can be frustrating for everyone involved, especially before a formal diagnosis of schizophrenia is made that explains them.

While these early signs may suggest the onset of schizophrenia, they can also point to other mental health issues, such as mood disorders, anxiety disorders, or age-related cognitive impairment. If you or a loved one has a family history of schizophrenia or other risk factors, like autoimmune disorders, certain infections, or neurological changes, or you notice ongoing or repeated symptoms, it’s important to consult a mental health professional.

Treatment for Late-Onset Schizophrenia

While there’s currently no cure for late-onset schizophrenia, many older adults manage their symptoms and lead fulfilling lives with appropriate treatment.

Antipsychotic medications are the most commonly prescribed drugs for schizophrenia. Before taking any antipsychotic medication, ask your doctor about the potential benefits, risks, and side effects. There are many options available, and finding the right one may take time.

Psychotherapy and family therapy are also part of a comprehensive schizophrenia treatment plan, especially once the initial symptoms are addressed. According to the American Psychiatric Association, support from family members plays a vital role in the overall health and well-being of individuals living with schizophrenia. Everyone in the family can benefit from mental health support and training.

Other helpful treatment strategies include social skills training, job training and support, and cognitive behavioral therapy, all of which can make daily life more manageable.

If you think you or a loved one may be experiencing late-onset schizophrenia, schedule an appointment with a healthcare provider or mental health professional. Getting help early can make daily life easier and improve treatment results. Remember, reaching out for support is a sign of strength, and you don’t have to face these challenges alone.

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