Psychopathology of early-onset versus late-onset schizophrenia revisited: an observation of 473 neuroleptic-naive patients before and after first-admission treatments.

Reports of potential differences in psychopathological presentations between early and late-onset schizophrenia have been controversial. However, such differences in first-episode neuroleptic-naive schizophrenic patients have not been discussed. The authors evaluated symptom profiles in 473 neuroleptic-naive schizophrenic patients before and after first-admission treatments. Both before and after treatment, (1) late-onset schizophrenia had a lower score on affective flattening/social withdrawal than did the earlier-onset counterpart of the illness, even after controlling for potential secondary sources of negative symptoms; (2) systematic persecutory delusion was more severe in patients with late-onset schizophrenia; and (3) the overall effect of age of onset on the psychopathological presentations was greater than the gender-related effects, including the interaction between age of onset and gender. Consideration of late-onset schizophrenia may be important in order to develop an etiologically and clinically reasonable conceptualization of the subtypes of schizophrenia. A factor-analytical study that attempts to compare directly the structure of broad psychopathological presentations in early and late-onset schizophrenia may be a reasonable approach to investigate the longstanding unsolved controversy as to whether or not the neurobiological backgrounds underlying the psychopathological presentations are comparable.