Introduction

Schizophrenia often occurs at an early age and the patient can then live well into old age, displaying persistent psychotic symptoms of various sorts. This is not controversial. However, the idea that schizophrenia could appear for the first time in middle age or among the elderly has been the subject of considerable argument for many years.

Nowadays there seems to be much wider acceptance that schizophrenia like illnesses can originate at any time from the teens onwards. It appears that, the older the age of onset, the more will the case resemble paranoid schizophrenia and the less significant will be the genetic component. Unhappily, there are still arguments, often based on ideological rather than scientific grounds, as to whether late onset cases should be regarded as schizophrenia or as something else (Stoudemire and Riether, 1987).

In the recent past, it has become common in the United States to diagnose schizophrenia of first onset in the elderly. This also happens to some extent in the United Kingdom, but notable arguments continue there about the differentiation of late paraphrenia from old-age schizophrenia. It probably makes little difference to the type of treatment which is applied if the case is called one or the other. However, if late paraphrenia is indeed paraphrenia as described in Chapter 7, but simply coming on for the first time in older age, then its prognosis might be somewhat better than that of a case of schizophrenia, at least in the short- to mid-term (Naguib, 1991).