Surprising new findings about late-life schizophrenia

ORLANDO – Quality of life is not static in older persons with early-onset schizophrenia, according to a prospective longitudinal study.

"What’s presented in the literature is that you reach an end stage in late-life schizophrenia, sometimes called the quiescent state, where nothing changes. Wrong! So get that out of your head. Our work and other recent studies suggest that symptoms fluctuate. Cognitive functioning fluctuates. Mood fluctuates. And quality of life and social functioning fluctuate. Our model suggests that there remain potential opportunities to impact quality of life among older adults with schizophrenia," Dr. Carl I. Cohen declared at the annual meeting of the American Association for Geriatric Psychiatry.

He presented a prospective study of 104 community-dwelling New Yorkers with schizophrenia diagnosed before age 45. They, along with 113 matched controls, were followed for a mean of 52 months starting at an average age of 61 years.

The primary outcome in this analysis was change in the Quality of Life Index (QLI), which scores four domains – health and functioning, socioeconomics, family, and psychological/spiritual life – on a 0-30 scale.

Over the course of 52 months, the mean QLI in the schizophrenia group barely budged, moving from 22.2 to 22.6. But that bland statistic hides some fascinating changes, Dr. Cohen noted. While 24% of those in the schizophrenia group experienced a significant decline in quality of life as reflected in a drop of 2.65 points or more on the QLI, which is one-half of a standard deviation, an additional 32% had a significant improvement in QLI score. Thus, nearly three-fifths of those in the schizophrenia group had more than a half standard deviation change in their QLI scores.

Moreover, 13% of the schizophrenia group had a low baseline quality of life based upon a QLI score below the mean for the control group of matched peers, but a high QLI score at follow-up. Conversely, 15% went from a high baseline QLI to a low quality of life score at follow-up, according to Dr. Cohen, professor of psychiatry and director of the division of geriatric psychiatry at SUNY (State University of New York) Downstate Medical Center, Brooklyn.

In a multivariate analysis, several predictors of a high QLI score at follow-up emerged: fewer depressive symptoms, a higher baseline QLI, and – in a novel finding – higher religiousness scores.

"This highlights the role that religious and spiritual beliefs and activities play in this population of older adults with schizophrenia," he observed.

Also, subjects who showed improvement in their QLI score over time experienced improvement in positive symptoms of schizophrenia. "Thus, enhancing quality of life has a direct clinical impact," Dr. Cohen continued.

Audience members congratulated him for shining light on an understudied population that’s often assumed to be totally burned out.

"I’ve always said the secret of schizophrenia is not so much the young people," Dr. Cohen replied, "but actually to understand the older patients who’ve gone through the illness in its different manifestations and to see how they’ve handled it. Many of them do improve in later life, and we can learn quite a bit."

The study was funded by the National Institute of General Medical Sciences. Dr. Cohen reported having no financial disclosures, although he added, "when I speak to an audience of psychiatrists, I always feel I ought to disclose something."

[email protected]

ORLANDO – Quality of life is not static in older persons with early-onset schizophrenia, according to a prospective longitudinal study.

"What’s presented in the literature is that you reach an end stage in late-life schizophrenia, sometimes called the quiescent state, where nothing changes. Wrong! So get that out of your head. Our work and other recent studies suggest that symptoms fluctuate. Cognitive functioning fluctuates. Mood fluctuates. And quality of life and social functioning fluctuate. Our model suggests that there remain potential opportunities to impact quality of life among older adults with schizophrenia," Dr. Carl I. Cohen declared at the annual meeting of the American Association for Geriatric Psychiatry.

He presented a prospective study of 104 community-dwelling New Yorkers with schizophrenia diagnosed before age 45. They, along with 113 matched controls, were followed for a mean of 52 months starting at an average age of 61 years.

The primary outcome in this analysis was change in the Quality of Life Index (QLI), which scores four domains – health and functioning, socioeconomics, family, and psychological/spiritual life – on a 0-30 scale.

Over the course of 52 months, the mean QLI in the schizophrenia group barely budged, moving from 22.2 to 22.6. But that bland statistic hides some fascinating changes, Dr. Cohen noted. While 24% of those in the schizophrenia group experienced a significant decline in quality of life as reflected in a drop of 2.65 points or more on the QLI, which is one-half of a standard deviation, an additional 32% had a significant improvement in QLI score. Thus, nearly three-fifths of those in the schizophrenia group had more than a half standard deviation change in their QLI scores.

Moreover, 13% of the schizophrenia group had a low baseline quality of life based upon a QLI score below the mean for the control group of matched peers, but a high QLI score at follow-up. Conversely, 15% went from a high baseline QLI to a low quality of life score at follow-up, according to Dr. Cohen, professor of psychiatry and director of the division of geriatric psychiatry at SUNY (State University of New York) Downstate Medical Center, Brooklyn.

In a multivariate analysis, several predictors of a high QLI score at follow-up emerged: fewer depressive symptoms, a higher baseline QLI, and – in a novel finding – higher religiousness scores.

"This highlights the role that religious and spiritual beliefs and activities play in this population of older adults with schizophrenia," he observed.

Also, subjects who showed improvement in their QLI score over time experienced improvement in positive symptoms of schizophrenia. "Thus, enhancing quality of life has a direct clinical impact," Dr. Cohen continued.

Audience members congratulated him for shining light on an understudied population that’s often assumed to be totally burned out.

"I’ve always said the secret of schizophrenia is not so much the young people," Dr. Cohen replied, "but actually to understand the older patients who’ve gone through the illness in its different manifestations and to see how they’ve handled it. Many of them do improve in later life, and we can learn quite a bit."

The study was funded by the National Institute of General Medical Sciences. Dr. Cohen reported having no financial disclosures, although he added, "when I speak to an audience of psychiatrists, I always feel I ought to disclose something."

[email protected]

ORLANDO – Quality of life is not static in older persons with early-onset schizophrenia, according to a prospective longitudinal study.

"What’s presented in the literature is that you reach an end stage in late-life schizophrenia, sometimes called the quiescent state, where nothing changes. Wrong! So get that out of your head. Our work and other recent studies suggest that symptoms fluctuate. Cognitive functioning fluctuates. Mood fluctuates. And quality of life and social functioning fluctuate. Our model suggests that there remain potential opportunities to impact quality of life among older adults with schizophrenia," Dr. Carl I. Cohen declared at the annual meeting of the American Association for Geriatric Psychiatry.

He presented a prospective study of 104 community-dwelling New Yorkers with schizophrenia diagnosed before age 45. They, along with 113 matched controls, were followed for a mean of 52 months starting at an average age of 61 years.

The primary outcome in this analysis was change in the Quality of Life Index (QLI), which scores four domains – health and functioning, socioeconomics, family, and psychological/spiritual life – on a 0-30 scale.

Over the course of 52 months, the mean QLI in the schizophrenia group barely budged, moving from 22.2 to 22.6. But that bland statistic hides some fascinating changes, Dr. Cohen noted. While 24% of those in the schizophrenia group experienced a significant decline in quality of life as reflected in a drop of 2.65 points or more on the QLI, which is one-half of a standard deviation, an additional 32% had a significant improvement in QLI score. Thus, nearly three-fifths of those in the schizophrenia group had more than a half standard deviation change in their QLI scores.

Moreover, 13% of the schizophrenia group had a low baseline quality of life based upon a QLI score below the mean for the control group of matched peers, but a high QLI score at follow-up. Conversely, 15% went from a high baseline QLI to a low quality of life score at follow-up, according to Dr. Cohen, professor of psychiatry and director of the division of geriatric psychiatry at SUNY (State University of New York) Downstate Medical Center, Brooklyn.

In a multivariate analysis, several predictors of a high QLI score at follow-up emerged: fewer depressive symptoms, a higher baseline QLI, and – in a novel finding – higher religiousness scores.

"This highlights the role that religious and spiritual beliefs and activities play in this population of older adults with schizophrenia," he observed.

Also, subjects who showed improvement in their QLI score over time experienced improvement in positive symptoms of schizophrenia. "Thus, enhancing quality of life has a direct clinical impact," Dr. Cohen continued.

Audience members congratulated him for shining light on an understudied population that’s often assumed to be totally burned out.

"I’ve always said the secret of schizophrenia is not so much the young people," Dr. Cohen replied, "but actually to understand the older patients who’ve gone through the illness in its different manifestations and to see how they’ve handled it. Many of them do improve in later life, and we can learn quite a bit."

The study was funded by the National Institute of General Medical Sciences. Dr. Cohen reported having no financial disclosures, although he added, "when I speak to an audience of psychiatrists, I always feel I ought to disclose something."

[email protected]