IS SCHIZOPHRENIA A DISORDER OF ALL AGES - A COMPARISON OF FIRST EPISODES AND EARLY COURSE ACROSS THE LIFE-CYCLE

Background. The heterogeneity of schizophrenic and delusional syndrome s by age of onset has frequently been discussed. Methods. The age dist ribution of symptoms and 5 year course was studied in a population-bas ed first-episode sample admitted to 10 psychiatric hospitals before th e age of 60 (N = 232) and in a clinical sample without age limit of co nsecutive first admissions to a single hospital (N = 1109), both sampl es with broadly diagnosed schizophrenia. Results. Early-onset patients , particularly men, presented more non-specific symptoms and higher PS E-CATEGO total scores than late-onset patients. In men, symptom severi ty decreased with increasing age of onset. In women, it remained stabl e except for an increase of negative symptoms with late-onset. Only a few symptoms changed markedly with age. disorganization decreased, whi le paranoid and systematic delusions increased steeply across the whol e age of onset range. Pronounced age-and sex-differences emerged in il lness behaviour, socially negative behaviour and substance abuse. With in the group of late-onset psychoses there were continuous transitions in symptom profiles and no discrimination between schizophrenia and p aranoid psychosis or late paraphrenia. The main determinant of social course was onset level of social development. Early-onset patients did not improve in social status, while late-onset patients, prior to ret irement, suffered considerable decline in social status. Conclusions. Gender differences in age at onset and in age trends in symptom severi ty support the hypothesis of a mild protective effect of oestrogen. So cial course results from an interplay between biological factors (age at onset and functional impairment) and development factors (level of social development at onset and illness behaviour).