New Perspectives on Late-Life Psychosis

hen Emil Kraepelin (1856e1926) made his Wnow famous quote, in which he states that the science of psychoses of old age are the “darkest area of psychiatry,” 259) he can hardly have anticipated that, over the next 100 years, it would become the opener to numerous talks, book chapters, and editorials about late-life schizophrenia. In his days, life expectancy was rather short, and the number of older patients with dementia praecox therefore rather small. He would not have thought that this patient group would one day be a major motor behind the crisis in geriatric mental health. The double graying of society (more older people who are living longer) together with better antipsychotic treatment and clinical care have resulted in the fact that today much larger numbers of people with schizophrenia are surviving into older age. Unfortunately, this increase has not been fully matched by increased scientific and public interest in this patient group. The field remains far detached from the booming science industry that propels research into schizophrenia at younger ages. The median incidence rate of schizophrenia is 15.2 per 100,000 person-years, with a median lifetime morbid risk of 0.4%. Onset typically peaks in late adolescence and early adulthood, and gradually declines thereafter, although a second peak in middleaged women has sometimes been noted, and some report increasing rates after the age of 65 years. Schizophrenia has been associated with an increased risk of suicide and all-cause mortality. As a consequence, older patients with schizophrenia constitute a subpopulation of survivors, skewed toward the