Functional Recovery in Late-Onset Schizophrenia: A Case Report

Abstract

Schizophrenia is typically characterized by an early adulthood onset and a chronic, frequently deteriorating course. However, late-onset schizophrenia (LOS), which occurs after age 40, presents distinct clinical challenges, particularly regarding differential diagnosis with neurodegenerative and cerebrovascular disease and the potential for functional recovery. We report the case of a 60-year-old woman with a continuous late-onset psychotic illness, comprising an approximately 12-month prodrome and an active phase extending beyond six months, characterized by persecutory and mystical-religious delusions, auditory and visual hallucinations, and progressive social isolation. An extensive organic work-up (including magnetic resonance imaging and 18F-FDG PET/CT) showed only mild age-related white matter microangiopathy and preserved cortical metabolism and did not indicate a neurodegenerative or space-occupying process. After optimization of low-dose risperidone, the patient achieved symptomatic remission and returned to her premorbid functional baseline, assessed clinically and by informant report, over approximately 22 months of follow-up before being lost to follow-up. This report illustrates the diagnostic challenge at the LOS/very-late-onset schizophrenia-like psychosis (VLOSLP) boundary and emphasizes that favorable functional outcomes are achievable in late-onset schizophrenia with appropriate multidisciplinary management and pharmacological adherence.