What is your experience with schizophrenia and aging, especially for those who have discontinued treatment?
Do positive and/or negative symptoms lessen with age, or is it the opposite?
My understanding is symptoms tend to lessen and sometimes appear to go into remission. Hard to say whether it’s a case of the disease running its course or people simply getting better at coping with it over time. For me it’s a little like a back injury I sustained in my twenties near to when I was diagnosed. It was acute at first and would lay me up from time to time to the point that I’d stay home from work. Nowadays I notice it, but I know what to do not to exacerbate it and get by just fine.
It’s important to note that schizophrenia is associated with shorter life expectancy with uncertain causes. Proposed explanations are poor lifestyle or inflammation both which can lead to a host of other diseases. Another consideration is the very real possibility of suicides, and other accidental and intentional deaths skewing these studies. That is, those who do better at coping with or recovering from the disease live longer, and those who die prematurely, leave the studied group and improve health and observed symptoms of their cohort.
But these are generalities. In my family, my older brother has gone largely untreated and has shown some cognitive and other mental decline along with periodic hospitalization and jail time with a diagnosis of Bipolar Disorder. Then again, he smokes and is an alcoholic. Whereas I’ve been treated and rarely drink, been hospitalized once and had steady employment and home life with a diagnosis of Schizoaffective Disorder. Even in this subset, it’s hard to separate lifestyle differences from the equation. And a great many of his cohorts are dead, so my mother says he must be something right, otherwise he wouldn’t be here. I’m not sure this is much of an answer, but I’d like to believe treatment improves lives overall, but barring that, people learn what coping mechanisms work for them and endure as best they can.
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My sister is 68. I do not know her actual diagnosis, but she has some kind of delusional disorder. She thinks her neighbours created a website about her that has gone viral and everyone reads it and everywhere she goes people follow her, talk about her and take her picture. She mostly stays indoors with the curtains closed and the lights off. When she does leave the house, she complains about being stalked, bullied and tormented by neighbours and strangers. It is really important to her that she is believed; she sobs if she thinks people distrust her stories.
My sister does not believe she has a mental illness per se, but admits to experiencing anxiety and depression. She believes she has a traumatic head injury and claims she has fallen on her face over 20 times. It is very hard for her as she is negative about life and constantly relives painful memories and frequently says she wishes she would die, although she has never articulated a plan. She eats a healthy diet, does not smoke or drink, has never taken illegal drugs, and her home is pretty cluttered but spotlessly clean. Except the windows are covered with aluminum foil and she sleeps under a foil-lined umbrella because people are shooting laser beams at her. She does not own a mobile phone, computer, microwave or credit card. My sister visited a psychiatrist until Covid, and then went to phone consults, and now only sees her family doctor. She has limiting beliefs about medication, stating that she has never been able to tolerate medications, and whenever she tries one, the side-effects are debilitating. For over a year, she has been taking a very low dose (25mg) of quetiapine, which was increased to 50mg about a month ago. She claims the increased dosage is causing her all kinds of negative reactions, from nausea to mental confusion and depression. Every stressful emotion she now attributes to the increase in medication. Even though the amount has doubled, it is still a sub-therapeutic dose.
All our family is negatively impacted by my sister’s behaviour, and our only hope has been that she would take medication that would improve her symptoms. However, she made up her mind even before she started the increased dose that it would not work for her, and plans to cut back. And 50 mg was nowhere near enough to affect her behaviour in the first place.
So, how are my sister’s MI symptoms affected as she ages? Definitely getting worse. When she tells me that the neighbours are going ballistic on her, I know it is she who is suffering. She also has a lot of memory loss and confusion, which she used to attribute to the head injury, but now says is caused by increased medication. My sister may have some dementia, but her doctor did not send her for an evaluation, other than administering the Montreal Cognitive Assessment, which identified short-term memory loss only. She is becoming very confused, and recently told me she forgot how to use the washing machine, and can’t reliably follow a recipe when baking, and baking was something she always excelled at. So there is definitely some cognitive decline on top of the delusional thinking and toxic negativity.
It is hard to feel any hope for her future. I try to talk to her about finding joy in life despite everything. She used to love nature and music and animals, but she is obsessed with the cruelty of others that she sees directed at her, and can’t let anything else in any more. She is also harshly judgemental of herself, and does a lot of negative self-talk. i.e. “I’m so stupid, I’m such an idiot. I’m a total failure”. I often say to her, “Treat yourself with the same kindness and compassion you would have for anyone else going through what you are experiencing.” And she just weeps, but doesn’t know how to be kind to herself. I wish there was some kind of counselling (or medication she would take) that could magically repair her disordered thinking and bring back the best of the person she used to be.
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I think some of the newer studies say that positive symptoms tend to decrease with age, but primarily for people who have received consistent, reliable treatment and medication. Which in the US is such a challenge.