Late Adulthood

On average, patients with schizophrenia have an improvement in both the severity of psychotic symptoms and their overall functioning in middle age (Harding et al., 1992). This improvement has led to speculation that the concentrations of testosterone and estrogen, which change with aging, play a role in the severity of symptoms, and in fact estrogen may augment the effect of antipsychotics in women.

Although there is an average improvement in function, the cognitive impairment found in schizophrenia does not appear to improve. There may also be a small percentage of patients who develop a dementia in later life that is due to schizophrenia and is not caused by other factors such as stroke, Alzheimer's disease, or the like. The distinctive features of deficit schizophrenia also fail to improve in later life, and their function remains poor. Some nondeficit subjects also have very severe psychotic symptoms that do not improve.

People with schizophrenia, on average, have a shortened life span. This is due to a number of factors, especially suicide and accidents (Siris, 2001). Patients with schizophrenia also have immunological changes as well as an increased prevalence of the metabolic syndrome, that is Type II diabetes, hypertension, other cardiovascular disease, and obesity. Antipsychotic medications certainly contribute to this problem, but it is possible that this is also a consequence of the abnormal development that causes psychotic symptoms.

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