When viewed across the lifespan, the incidence of schizophrenia shows strong age-group differences. (33) In males, the incidence rises steeply in adolescence, reaching a peak in the early twenties and then steadily declines to old age. Females show a similar rise in young adulthood with a subsequent drop, but there is also a second peak around the time of menopause. This second peak may occur because oestrogen delays the onset of schizophrenia in some vulnerable women. In younger adults, males have a higher incidence of schizophrenia, whereas in later life females have the higher incidence.
The prevalence, as well as the incidence, of schizophrenia appears to be low in the elderly. However, while almost all younger adults with schizophrenia or paranoid disorders come to treatment, it is believed that a considerable proportion of the elderly refuse treatment because of suspiciousness, they are not recognized to have a treatable disorder, or their behaviour is attributed to senility.
Although prevalence is lower than in younger adults, within the elderly group the prevalence of schizophrenia and paranoid disorders appears to increase with age. Moreover, psychotic states can be viewed as a continuum in the population, ranging from mild symptoms such as paranoid ideas to a diagnosable disorder. Psychotic symptoms are much more common in the elderly than psychotic disorders. Factors associated with psychotic symptoms include female gender, impaired hearing and vision, social isolation, and cognitive impairment. (34) In the case of social isolation, it is unclear whether this is a cause or an effect. Psychotic symptoms are common in dementia, but differ from those found in schizophrenia or paranoid disorders in that they can arise due to misunderstandings associated with memory or intellectual impairment.
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