Jalenques Isabelle, Rachez Chloé, Tourtauchaux Rémi, Cellier Yannick, Legrand Guillaume
Service de psychiatrie de l'adulte A et psychologie médicale, Pôle de psychiatrie, CHU de Clermont-Ferrand, Clermont-Ferrand.
Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep;9(3):345-53. doi: 10.1684/pnv.2011.0285.
Although some patients suffering from schizophrenia experience an age-related amelioration, a great number of people who are entering old age suffer from long-standing schizophrenia. These patients show specific psychiatric and somatic problems that must be taken into account. Firstly, some display high levels of all schizophrenic symptoms, while others experience changes in the symptom profile with aging, i.e. a reduction in positive symptoms and an increase in negative ones. Secondly, the occurrence of significant depressive symptoms among elderly patients with schizophrenia is well recognized. Thirdly, in recent years, studies have begun to shed more light on the trajectories of cognitive impairment of these patients in old age. Lastly, aged persons with schizophrenia often have side effects due to long-term antipsychotic medications and medical co-morbidity, more untreated somatic disorders (diabetes, cardiovascular diseases) and higher mortality rates. These may be the result of both lifestyle factors and lack of adequate medical care. Levels of adaptive functioning and quality of life are closely associated with clinical and social factors. Thus, we must consider all these different aspects in order to effectively manage the therapeutic and service needs of these patients.
虽然一些精神分裂症患者会随着年龄增长病情有所改善，但大量步入老年的人患有长期的精神分裂症。这些患者存在一些必须予以考虑的特定精神和躯体问题。首先，一些患者所有精神分裂症症状的水平都很高，而另一些患者的症状表现会随着年龄增长而变化，即阳性症状减少，阴性症状增加。其次，老年精神分裂症患者中出现显著抑郁症状的情况已得到充分认识。第三，近年来，研究开始更深入地揭示这些患者老年期认知障碍的发展轨迹。最后，患有精神分裂症的老年人由于长期服用抗精神病药物和合并其他疾病，往往会出现副作用，有更多未治疗的躯体疾病（糖尿病、心血管疾病），死亡率也更高。这些可能是生活方式因素和缺乏充分医疗护理共同导致的结果。适应功能水平和生活质量与临床及社会因素密切相关。因此，为了有效满足这些患者的治疗和服务需求，我们必须考虑所有这些不同方面。
