Cort, E; Meehan, J; Reeves, S; Howard, R; (2018) Very Late–Onset Schizophrenia-Like Psychosis: A Clinical Update. Journal of Psychosocial Nursing and Mental Health Services , 56 (1) pp. 37-47. 10.3928/02793695-20170929-02.

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Abstract

Psychosis symptoms (delusions and hallucinations) are multifactorial in origin and, in later life, occur in the context of schizophrenia, delirium, dementia, delusional and schizophrenia-like disorders, mood disorders, and alcohol or substance abuse. The current article provides a clinical overview of very late–onset (after age 60) schizophrenia-like psychosis (VLOSLP), summarizing the literature on treatment options and reflecting on the role of psychiatric–mental health nurses (PMHNs). Increased awareness of the clinical presentation, key features, and evidence-based treatment options will assist PMHNs to confidently recognize this often under-diagnosed disorder and adopt a more assertive role in terms of engagement and follow up. Pragmatic research involving individuals with VLOSLP is required to increase the evidence base for treatment and improve outcomes of care. [Journal of Psychosocial Nursing and Mental Health Services, 56(1), 37–47.] It has long been acknowledged that psychotic illness can lead to alienation, discrimination, and isolation (Burke & Shome, 1998), and older adults with psychosis represent one of the most disenfranchised groups in relation to health care (Mitford, Reay, McCabe, Paxton, & Turkington, 2010). In the older adult mental health setting, nurses encounter two main groups with a schizophrenia diagnosis: (a) individuals with early-onset schizophrenia (EOS) who have grown old, and (b) those who experience the onset of psychosis in later life, either as late-onset (after age 40) schizophrenia (LOS) or very late–onset (after age 60) schizophrenia-like psychosis (VLOSLP). Older adults with schizophrenia have been somewhat neglected historically by the scientific research community (Cohen et al., 2008; Folsom et al., 2006), and there is a significant gap between the high prevalence of psychotic disorders in older adults and the availability of evidence-based treatments (Reinhardt & Cohen, 2015). This gap leaves health care systems ill-prepared to manage the predicted substantial growth in the older adult population (Cohen, Meesters, & Zhao, 2015). Drawing on the published literature and the current authors' clinical and research experience, the current article reflects on VLOSLP from a person-centered, biopsychopharmacosocial mental nursing perspective (Clarke & Clarke, 2014), describing clinical presentation and treatment interventions. A search of PubMed and CINAHL using “very late-onset schizophrenia-like psychosis” and a range of related terms combined with (mental health/psychiatric) nursing revealed very little attention specifically relating to mental health nursing care of this patient group, although information is available in relation to generically supporting older adults experiencing psychosis, schizophrenia, or both.

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