Clinical and neuroimmunologic characteristics of late onset of schizophrenia and schizophrenia-like psychoses

BACKGROUND. After dementia and depression, schizophrenia-like psychoses with very late onset is the largest diagnostic group among late onset mental diseases. Last studies have shown the clinical heterogeneity of these psychoses.

AIM. Determine the clinical forms of late-onset psychoses, their corresponding immunological correlates and their diagnostic significance.

MATERIAL AND METHODS. 25 patients with late onset psychoses, mean age 64.8±6.0 years, age of onset of the disease 69.8±7.99 years were examined. The control group consisted of 14 people (9 women, 5 men) without mental disorders, mean age 64.8±6.0 years. Clinical and psychopathological examination was carried out, and assessment using psychometric scales (PANSS, HAMD, MoCA, MMSE). Immunological parameters were assessed: leukocyte elastase, α1-proteinase inhibitor, their ratio — proteinase inhibitor index, levels of autoantibodies to neuroantigens — protein S100b and basic myelin protein. Cluster analysis, as well as the t-criteria, Kruskal–Wallis, U Manna–Withney methods were used as the main approach to statistical data processing

RESULTS. Three groups of patients were identified — a group with acute polymorphic psychotic symptoms, characterized by the severity of the pathological process, heterogeneous psychotic symptoms, pronounced cognitive decline, lack of significant dynamics in the treatment process; a group of patients with a predominance of “involutional color” of psychosis, characterized by a continuous course with incomplete remission and little response to therapy; group of affective-delusional psychoses with paroxysmal course, low severity of cognitive impairment, good response to therapy.

CONCLUSION. The clinical heterogeneity of the group of late manifesting psychoses was determined, the immunological features inherent in each group, their prognostic significance were highlighted.