Does Schizophrenia Progress as You Age?

People with schizophrenia often experience a distorted reality that impacts relationships, social functioning, and other daily activities like work. According to the National Institute of Mental Health (NIMH), these distortions can include:

• delusions
• hallucinations
• disorganized speech or movements
• trouble with thinking and motivation

Data from several studies suggest that people with schizophrenia typically experience the worst symptoms in the first episode of psychosis, followed by modest improvements over midlife and then a decline later in life.

Also, a 2016 study indicates that the size of the brains of those living with the disorder tends to shrink more quickly than those with the chronological age of the brain itself. This may result in cognitive and emotional decline.

In addition, older adults with schizophrenia experience a higher rate of adverse side effects from psychotropic medications. Some people experiencing the side effects stop taking their medication, leading to worsened conditions.

Some people living with schizophrenia may find that the effects of their medications have worn off. The reason is unknown, though one possibility could be the medication is no longer working. Another possible cause is altered brain biology.

Another factor that can contribute to the worsening of the condition is dementia. As cognitive decline can occur in people with schizophrenia and those living with dementia, those living with schizophrenia may experience further cognitive decline if they develop dementia later in life.

In fact, people living with schizophrenia may have twice as much risk of developing dementia than those who don’t have the condition. The relative risk seems to be particularly high in those with schizophrenia who are younger than 65 years old.

Successful treatment of schizophrenia requires medical interventions, such as medication and lifestyle modifications. In most cases, the right treatment plan works well.

Sometimes, though, symptoms can suddenly worsen or become more frequent despite medications and consistently following lifestyle recommendations.

A doctor may consider schizophrenia regression as a possible cause when this happens. Having an honest discussion with your doctor is essential to find out the best course of action when regression occurs.

If you or a loved one lives with schizophrenia, finding ways to manage the ups and downs as time goes on is critical to your overall quality of life. Here are several tips to consider that may help you manage symptoms of schizophrenia:

Keep body and mind active

Julian Lagoy, MD, a psychiatrist with Mindpath Health who is based in San Jose, California, says the advice he would give a person with schizophrenia who is getting older is the same advice he would give to someone who has a family history of dementia:

• exercise frequently
• engage in regular social interactions
• maintain a healthy diet

“Taking these steps will help get the brain adequate blood flow and also reduce psychosocial stressors, which is a trigger for schizophrenia,” he says.

Nurture your network

Because symptoms of schizophrenia may cause you to feel disconnected at times, creating and maintaining a supportive social network is key to managing schizophrenia as you age.

When you want to talk about changes in your symptoms, having a close relationship with family members and a primary healthcare professional can be helpful.

Also, having a family member with you at doctor appointments can help you keep track of detailed changes in treatment and medications.

Find solace in structure

Maintaining a structured schedule and developing routines can be extremely helpful when symptoms become tough to manage. This is especially important for preserving and improving cognitive function in aging adults with schizophrenia.

Practice perspective

Finally, finding meaning and purpose in life is essential. Vanessa Kennedy, PhD, director of psychology at Driftwood Recovery in Texas, says schizophrenia is a health condition based on genetic predisposition, but it’s not all of who you are.

“Make sure you take a well-rounded perspective of your health and wellness and continue activities that keep you stimulated, engaged, and happy,” she adds.

Research is ongoing to address the many questions about schizophrenia. Here are the answers frequently asked by people with schizophrenia or their loved ones:

Does schizophrenia ever go away?

Schizophrenia never really goes away. There’s no cure for this complex psychological condition, but you can manage the symptoms.

At what age does schizophrenia get prominent?

On average, the age of onset for schizophrenia is the late teens to early 30s, according to the NIMH. If left untreated, schizophrenia can worsen at any age, especially if you continue to experience episodes and symptoms.

Typically, early onset schizophrenia in the late teens tends to be associated more with severe symptoms than later-life onset.

But aging can change the trajectory of how symptoms show up. In older adults with early onset schizophrenia, aging tends to be associated with:

• a reduction of psychotic symptoms and risk of hospitalization
• improved psychosocial function
• less substance use
• improved mental health-related quality of life

Although it’s less common for people to be diagnosed with schizophrenia after 40 years old, new information suggests late onset is becoming more common.

People with late onset tend to have a relatively better outlook and require lower daily dosages of antipsychotic medications than those diagnosed earlier in life.

What’s the average lifespan of a person with schizophrenia?

Adding to the complexity of this mental health condition is the possibility of a shortened lifespan.

Data from a 2013 study show the average life expectancy of people with schizophrenia is 12 to 15 years shorter than for those who don’t live with the condition.

Another study indicates the average life span to be 20 to 23 years shorter than those without the condition. Two potential causes of premature death include undiagnosed heart disease and cancer.

Researchers also found that a lack of antipsychotic treatment was associated with greater all-cause mortality in this group.

Does schizophrenia get worse if untreated?

Symptoms of schizophrenia rarely get better without treatment. Without the proper treatment, symptoms can occur more often and increase in intensity.

“With each untreated psychotic episode, the brain becomes more vulnerable to having a more severe or prolonged attack that could be resistant to medication,” says Kennedy.

Also, untreated symptoms can contribute to other mental health difficulties, such as depression or suicidal ideation, she adds. Because of this, Kennedy tries to instill hope in her clients diagnosed with schizophrenia.

“There are plenty of new medications with fewer side effects, including longer-acting injectables that can help older clients manage symptoms without the hassle of having to remember to take a pill every day,” she says. “It’s still possible to manage symptoms and meet your long-term goals.”

By learning more about schizophrenia, you’ve already taken a pivotal first step in understanding how to manage symptoms and finding new ways to cope over time.

Working with a doctor, support team, and loved ones can help you avoid schizophrenia regression and ensure your treatment plan is working.

You can also consider looking into advocacy groups such as the Schizophrenia & Psychosis Action Alliance. They can provide you and your family, loved ones, caregivers, and friends with resources and support to manage your condition as you age.