The majority of patients diagnosed with first episode psychosis (61.8%) were over age 35, according to new study findings.
The study, published in Psychiatry Research, included 854 patients aged 18-65 from community psychiatric services between 2012 and 2021 in Ferrara, Italy.
Older patients, particularly women, showed a secondary peak in psychosis incidence in their mid-late 40s, underlining potential sex-specific vulnerabilities, according to study investigators. Women in the older age group were less frequently prescribed long-acting injectable antipsychotics compared to men (3.7% vs 10.0%).
Older adults required more diverse support including from social workers and general practitioners, reflecting the longer duration of untreated psychosis (up to 20 years) and broader health care needs in this group. The study found that 47.2% of older adults were hospitalized compared to 63.5% of younger patients under 35.
There was a notable difference found in medication prescriptions, with older adults (aged 36+) more likely to receive antidepressants (15.3% vs 8.0%), indicating possible differences in clinical presentation or assumptions about treatment compliance. Long-acting injectable antipsychotics were less frequently prescribed for the older group compared to the younger group under 35 (6.3% vs 9.0%).
Older adults were more likely to be married (27.8% vs 6.1%) or living independently (10.8% vs 5.8%), have lower rates of hospitalization (47.2% vs 63.5%), and display higher diagnoses of episodic mood disorders (21.6% vs 13.5%) and delusional disorders (22.2% vs 19.0%) compared to younger patients.
The findings suggest that current early intervention programs, primarily designed for younger populations, may not fully meet the needs of older adults. The study authors note that adjustments to these services could address the specific clinical and social realities of this demographic, such as higher rates of being married or living independently, which influences support needs and potential caregiver dynamics.
The authors declared having no competing interests.