International Psychogeriatrics

Research Article

Dimensions of positive symptoms in late versus early onset psychosis

Oliver Masona1a2 c1, Joshua Stotta1 and Ruth Sweetinga1

a1 Research Department of Clinical, Educational and Health Psychology, University College London, London, UK

a2 North East London Foundation NHS Trust, Ilford, UK


Background: Casenote studies have characterized late onset schizophrenia (LOS) and related psychoses as somewhat different symptomatically from patients with an early onset schizophrenia (EOS). This study examined a range of phenomenological aspects of delusions and hallucinations as well as traditional symptom measures in both groups.

Methods: 34 LOS and 235 EOS completed the Positive and Negative Syndrome Scale, the Psychotic Symptom Rating Scales, and the Beck Depression and Anxiety inventories. Subgroups experiencing delusions were compared matching for chronological age and gender, and also when matched for chronicity and gender.

Results: Delusions were very common at over 80% in both groups. LOS participants with delusions exhibited greater suspiciousness/paranoia, greater belief-conviction, and reduced insight when compared with the EOS group. These findings remained when matching for chronicity of illness, but disappeared when matching for chronological age. Hallucinations were surprisingly rarer in LOS (35%) than EOS (57%), with half the LOS group reporting whispers rather than clearly audible sounds. In general, anxiety, depression, and distress were as marked in LOS and EOS.

Conclusions: Similarities between EOS and LOS far outweighed the differences across a range of symptoms and measures. Greater delusional conviction, paranoia, and poorer insight in LOS were associated with the later age of onset rather than relating to chronicity of illness. As belief-conviction in LOS was not associated with increased grandiosity, disorientation, or unusualness of thought content, as it was in EOS, delusional conviction may be determined somewhat differently later in life.

(Received June 22 2012)

(Reviewed August 08 2012)

(Revised September 24 2012)

(Accepted September 25 2012)

(Online publication October 23 2012)

Key words:

  • late onset schizophrenia;
  • delusions;
  • hallucinations


c1 Correspondence should be addressed to: Dr. Oliver Mason, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK. Phone: +44-0207-679-8230; Fax: +44-0207-916-1989. Email: