Very Late-Onset Schizophrenia-Like Psychosis: A Case Report and Critical Literature Review

Joana Regala; Francisco Moniz-Pereira

doi:10.4235/agmr.23.0026

Ann Geriatr Med Res > Accepted Articles

Case Report

DOI: https://doi.org/10.4235/agmr.23.0026 [Accepted]
Published online April 27, 2023.

Very Late-Onset Schizophrenia-Like Psychosis: A Case Report and Critical Literature Review

Joana Regala¹

, Francisco Moniz-Pereira^1,2

¹Department of Psychiatry, Júlio de Matos Hospital (Psychiatric Hospital Centre of Lisbon), Lisbon, Portugal
²Department of Psychology, Universidade Autónoma de Lisboa, Lisbon, Portugal

Correspondence: Joana Regala,
Email: joanaregala@gmail.com

Received: 21 February 2023 • Accepted: 22 April 2023

Abstract

Late-life psychosis presents a challenge, wherein a wide range of differential diagnoses should be considered. Very late-onset schizophrenia-like psychosis (VLOSLP) is a nosological entity that remains a conundrum. We provide a comprehensive literature review on the neurobiological underpinnings of VLOSLP. We describe a case that typifies the clinical presentation of VLOSLP. Although not pathognomonic, certain features, namely the two-stage progression of psychotic episode, partition delusions, multimodal hallucinations, and absent formal thought disorder or negative symptoms, are quite suggestive of VLOSLP. Several medical causes that might cause late-life psychosis, including neuroinflammatory/immunology diseases, were ruled out. Neuroimaging revealed basal ganglia lacunar infarctions along with chronic white matter small-vessel ischemic disease. The diagnosis of VLOSLP is based on clinical evidence, and the aforementioned clinical features support this diagnostic hypothesis. This case adds to the growing body of evidence pertaining to the relevance of cerebrovascular risk factors in the pathophysiology of VLOSLP, alongside age-specific neurobiological processes. We hypothesized that microvascular brain lesions disrupt the frontal-subcortical circuitry and uncover other core neuropathological processes. Future research should focus on identifying a specific biomarker that would allow clinicians to more accurately diagnose VLOSLP, differentiate it from other overlapping clinical entities such as dementia or post-stroke psychosis, and provide a tailored treatment for the patient.

Key Words: Schizophrenia, Somatic hallucinations, Gustatory hallucinations, Formed of people hallucinations