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Background: The aims of this study were to analyze prevalence and severity of vascular risk factors in older patients referred to our clinic due to onset of Very Late-Onset Schizophrenia-Like Psychosis (VLOSLP) and to create a specific phenotype based on pathophysiological insight rather than age of onset. Methods: In a longitudinal study, 103 (M = 39, F = 64; mean age of 80.32 ± 7.65 years) patients were evaluated with cognitive, neuropsychiatric, and functional assessment scales. Blood concentration of hemoglobin (Hb), mean corpuscular volume (MCV), platelets, total protein test (TPT), creatinine, azotemia, glycemia, total cholesterol (TC), triglycerides (TG), uric acid (UA), sodium (Na), potassium (K), chlorine (Cl), calcium (Ca), folate, vitamin B12 (Vit-B12), and homocysteine were measured. Presence/absence of tobacco use, alcohol consumption, psychoactive substance use, hypertension, hyperlipidemia, diabetes mellitus, and history of vascular disease were collected. Results: Females were more apathetic than males (NPI-Apathy: p = 0.040). Males had a significantly higher level of Hb (p = 0.019) and UA (p = 0.001), and a lower level of platelets (p = 0.004) and Ca (p = 0.003), and used more tobacco (p = 0.046) and alcohol (p = 0.024) than females. Comparing patients < 80 and ≥80 years, we found differences in frequency of vascular risk factors among men (p = 0.027). In total, 102 patients were treated for psychosis (59.16% of them were using atypical antipsychotics). Conclusions: The results of this study could be useful for a progressive demonstration of the causal relationship between cardiac and cerebral vascular events and VLOSLP. Full article

Epidemiological and clinical studies have uniformly reported an overrepresentation of females with very-late-onset schizophrenia-like psychotic disorder (VLOS), in stark contrast to the sex distribution of early-onset schizophrenia. Various explanatory models have been proposed to account for these sex differences, including (a) antidopaminergic effects of estrogen, (b) differential vulnerability to subtypes, (c) neurodegenerative differences between the sexes, and (d) and sex differences in age-related psychosocial and neurological risk factors; however, these models have not yet been critically evaluated for their validity. Keywords related to VLOS symptomatology, epidemiology, and sex/gender were entered into the PubMed, MEDLINE, and Google Scholar databases spanning all years. Through a narrative review of symptomatology and pathophysiology of VLOS, we examine the strengths and limitations of the proposed models. We present a comprehensive biopsychosocial perspective to integrate the above models with a focus on the role of neuroinflammation. There is significant room for further research into the mechanisms of VLOS that may help to explain the female preponderance; the effects of estrogen and menopause, neuroinflammation, and dopaminergic transmission; and their interaction with age-related and lifetime psychosocial stressors and underlying biological vulnerabilities. Full article