As in younger patients with schizophrenia, cognitivebehavioral therapy can help to modify delusional beliefs, gain control over hallucinations, and identify high-risk situations and appropriate coping strategies.23
Include family members in the treatment plan, and offer them support, education, and practical assistance (e.g., strategies for dealing with delusions). Informed families can help patients comply with prescriptions and appointments and can also detect relapse in its early stages.
In some cases, the patient’s longstanding paranoia and paranoid personality can lead to resentment and conflict within the family. Before treatment can begin, you may also need to address this conflict by educating family members on how a loved one’s schizophrenia affects them. Counseling the family as a group may be appropriate in some cases.
Related resources
Howard R, Rabins PV, Castle DJ, eds. Late onset schizophrenia. Petersfield, UK: Wrightson Biomedical; 1999.
Howard R, Rabins PV, Seeman MV, et al. Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. Am J Psychiatry 2000; 157:172-8.
Drug brand names
Clozapine • Clozaril
Olanzapine • Zyprexa
Quetiapine • Seroquel
Risperidone • Risperdal
Disclosure
The authors report no affiliation or financial arrangement with any of the companies whose products are mentioned in this article, or with manufacturers of competing products.
Acknowledgements
Dr. Lubman wishes to thank the Nauma Licht Fellowship, a bequest supporting schizophrenia research, for its support.
