SAN DIEGO – According to Dr. Dilip V. Jeste, aging presents mankind with a paradox: Physical health may decline, but psychosocial functioning often improves with age, even in people with serious illnesses.
In a longitudinal study conducted for more than 2 decades by Dr. Jeste and his associates at the University of California, San Diego, researchers are following more than 1,400 community-based middle-aged and older adults with schizophrenia and 300-plus healthy controls with comprehensive clinical, neuropsychological, and functional evaluations. To date, they have observed accelerated physical aging among patients with schizophrenia, compared with controls, with a high morbidity and a lifespan shorter by 20 years, tied in most cases to heart disease and other afflictions common in older age. (Schizophr Bull. 2011;37[3]:451-5. doi:1093/schbul/sbr026).
Dr. Dilip V. Jeste
They also have observed mild cognitive deficits at baseline, but a normal rate of age-associated impairment, as well as improving mental health, a reduction in psychotic symptoms, substance abuse, psychotic relapses, and increased treatment adherence, “because they have learned from experience that when they stop treatment, they have a relapse, and may become suicidal, agitated, and in need of hospitalization,” Dr. Jeste, a distinguished professor of psychiatry and neurosciences at UCSD, said at the annual U.S. Psychiatric and Mental Health Congress. “They don’t want that. Older people with schizophrenia get hospitalized not because of their psychosis, but because of the physical problems.”
More recently, he and his associates have been using biomarkers of aging to longitudinally study 140 outpatients with schizophrenia and 120 healthy controls aged 26-65 years. Data from the full sample have not yet been published, but the mean age of study participants was 50 years and 52% were male. Compared with controls, patients with schizophrenia had worse scores on psychopathology, physical functioning, and cognitive performance, “which is what you would expect.”
However, the researchers also observed shorter telomeres in some patients with schizophrenia. A telomere is a segment of DNA at the end of chromosomes. “Every time a cell divides, the telomere becomes shorter,” explained Dr. Jeste, who also is director of UCSD’s Stein Institute for Research on Aging. “After multiple cell divisions, the telomere disappears, and the cell dies.” The researchers found that women controls had significantly longer telomeres, compared with male controls (unpublished data). “That is consistent with the fact that women live longer than men,” he said. “That’s not surprising. What was surprising is that we did not see this gender difference in patients with schizophrenia. That means that women with schizophrenia have shorter telomeres than women controls. At this time, we don’t know what to make of this finding, but we will pursue it.”
The researchers also observed that the more severe the Calgary Depression Scale scores among patients, the shorter their telomeres, suggesting potential seriousness of depression in schizophrenia.
In an earlier study of 145 community-based middle-aged and older persons with schizophrenia, predictors of sustained remission were having social support, being (or having been) married at least once, greater cognitive/personality reserve, and early initiation of treatment, but not age or duration of illness (Am J Psychiatry. 2004;161[8]1490-3). “It’s worth keeping in mind that even older people with schizophrenia can have sustained remission,” Dr. Jeste said. He cited the late John Nash, Ph.D., – the Nobel Prize winning mathematician whose life story was the subject of the movie “A Beautiful Mind”– as someone who can function “at a very high level in spite of a serious illness like schizophrenia.”
This also occurs in adults with HIV and cancer, he continued. A “substantial proportion” of these patients demonstrate high ratings on mental well-being, despite worse physical health and more stressors (J Clin Psychiatry. 2013 May;74[5]:e417-23. doi: 10.4088/JCP.12m08100), (Psychooncology. 2015 Feb;24[2]:241-4. doi: 10.1002/pon.3600) and (Schizophr Res. 2014 Oct;159[1]:151-6. doi: 10.1016/j.schres.2014.07.02). Predictors of well-being in these patients include high levels of resilience and optimism, and low levels of depression and perceived stress.
These same “successful aging” traits were observed in a longitudinal study of a randomly selected community-based sample of 2,100 San Diego County residents aged 21-100. Known as the SAGE study, Dr. Jeste and his associates set out to test hypotheses regarding different domains of successful aging: physical, cognitive, and psychosocial. They found that aging is associated with declining levels of physical function yet improving mental health. Moreover, the study participants reported being more satisfied with life as they advance in age. The most significant correlates to self-reported well-being, happiness, and satisfaction in life were high levels of resilience and optimism, and low levels of depression and perceived stress (Am J Psychiatry. 2013 Feb;170[2]:188-96. doi: 10.1176/appi.ajp.2012.12030386).