CLINICAL HANDBOOK OF SCHIZOPHRENIA

396 VI. SPECIAL POPULATIONS AND PROBLEMSclinicians should be cognizant of cognitive changes in patients that may signify normalaging or co-occurring disorders that cause dementia.KEY POINTS• A majority of older adults with schizophrenia have had the illness since they were youngadults.• New onset of schizophrenia after age 40 can occur, but it is less common and has importantclinical differences than early-onset illness.• Antipsychotic medications are useful for late-life schizophrenia, but may have more side effectsin older than in younger adults, often requiring reduced doses.• Choice of antipsychotic medication should be guided in part by an individual patient’s preferences,as well as risks for different side effects.• Psychosocial treatments, such as skills training, cognitive-behavioral techniques, and supportedemployment, are effective adjuncts to pharmacotherapy in late-life schizophrenia.• Psychosocial treatments may improve residual impairments in role functioning even amongpersons who are responsive to medications.• Medical comorbidity is common in older persons with schizophrenia, and mental health cliniciansshould facilitate proper medical care for these patients.• The prognosis for aging individuals with schizophrenia is not as bleak as once thought, becausepositive symptoms often improve with age.• Sustained remission occurs in a minority of aging persons with schizophrenia, and its likelihoodmay be increased by improved social support.REFERENCES AND RECOMMENDED READINGSBartels, S. J., Forester, B., Mueser, K. T., Miles, K. M., Dums, A. R., Pratt, S. I., et al. (2004). Enhancedskills training and health care management for older persons with severe mental illness. CommunityMental Health Journal, 40, 75–90.Folsom, D. P., Lebowitz, B. D., Lindamer, L. A., Palmer, B. W., Patterson, T. L., & Jeste, D. V. (2006).Schizophrenia in late life: Emerging issues. Dialogues in Clinical Neuroscience, 8, 45–52.Goff, D. C., Cather, C., Evins, A. E., Henderson, D. C., Freudenreich, O., Copeland, P. M., et al.(2005). Medical morbidity and mortality in schizophrenia: Guidelines for psychiatrists. Journalof Clinical Psychiatry, 66, 183–194.Granholm, E., McQuaid, J. R., McClure, F. S., Auslander, L. A., Perivoliotis, D., Pedrelli, P., et al.(2005). A randomized, controlled trial of cognitive behavioral social skills training for middleagedand older outpatients with chronic schizophrenia. American Journal of Psychiatry, 162,520–529.Harris, M. J., & Jeste, D. V. (1988). Late-onset schizophrenia: An overview. Schizophrenia Bulletin,14, 39–55.Jeste, D. V., Barak, Y., Madhusoodanan, S., Grossman, F., & Gharabawi, G. (2003). An internationalmultisite double-blind trial of the atypical antipsychotic risperidone and olanzapine in 175 elderlypatients with chronic schizophrenia. American Journal of Geriatric Psychiatry, 11, 638–647.Jeste, D. V., Dolder, C. R., Nayak, G. V., & Salzman, C. (2005). Atypical antipsychotics in elderly patientswith dementia or schizophrenia: Review of recent literature. Harvard Review of Psychiatry,13, 340–351.Jeste, D. V., Rockwell, E., Harris, M. J., Lohr, J. B., & Lacro, J. (1999). Conventional vs. newerantipsychotics in elderly patients. American Journal of Geriatric Psychiatry, 7, 70–76.Marriott, R. G., Neil, W., & Waddingham, S. (2006). Antipsychotic medication for elderly peoplewith schizophrenia. Cochrane Database of Systematic Reviews, 25, CD005580.Palmer, B. W., McClure, F., & Jeste, D. V. (2001). Schizophrenia in late-life: Findings challenge traditionalconcepts. Harvard Review of Psychiatry, 9, 51–58.