I’ve read it in many forms, but the truism is something like “If you have no signs of schizophrenia by age 30, you most likely won’t ever have it, even if people in your family did.”
What I’m trying to understand is - does that mean your brain is only prone to schizophrenia during certain hormonal events from age 0-30 but by age 30 you’re fully developed and now the concrete has hardened? In other words, during 0-30, your brain was like soft wet cement and any major trauma or hormone event would be like someone stepping a foot into wet cement, it can leave an imprint (schizophrenia,) but once the concrete hardens then no amount of foot-trodding is going to leave any mark?
Or does it mean something else, like your brain will always carry some dormant seed for schizo (because of family genes) and if you get deployed to war and/or you experience severe PTSD-traumatizing things, torture, loved ones dying, etc., that you could still get schizo anyway (whereas a normal person with no family gene would merely suffer PTSD but no schizophrenia?)
It sounds to me like an “old wives tale” more than a truism according to this scholarly article.
“Schizophrenia in late life is emerging as a major public health concern worldwide… the number of persons over age 65 with a major psychiatric disorder will be roughly equal to the number of people aged 30 to 44 with a similar disorder.”
I don’t think that’s what “most likely” means. Wouldn’t it still be true that you “most likely” won’t ever have that even if you were, say, 20% likely to have it after turning thirty? Or 40%? (Or even 49%?)
The argument I’ve heard is that the root cause of schizophrenia is that when you’re a child your brain produces a lot of neural connections and then it starts to prune them back in your late teens and early 20s. This process going wrong and the wrong neural connections being pruned is what causes schizophrenia.
If you don’t develop schizophrenia during this period, you probably won’t develop it at all because this process only occurs during a period in your teens and 20s.
Thats my understanding of what the saying means. I’m not an expert.
Brains of individuals with schizophrenia, for example, have fewer synapses than normal. Some researchers have hypothesized that excess synaptic pruning could trigger the disease—likely during the active period of synapse elimination in adolescence, which coincides with the typical onset of schizophrenia.
I think all it means is that over 50% of people who go on to develop schizophrenia will show symptoms before age 30. It doesn’t really say how it works, because scientists don’t really know. There are various hypotheses, but none have been proven.
In short, both scenarios you give could be more-or-less correct. Heck, it’s possible that what we call schizophrenia isn’t even one disorder–the post-30 onset may have a different etiology.
Schizophrenia tends to get diagnosed somewhere between the early teens and the early thirties. It tends to get diagnosed slightly earlier in men than in women. In the movie A Beautiful Mind, it is made to appear that John Nash didn’t show symptoms until he was 40. This is one of the many ways that the movie is inaccurate.
I think there is a lot potentially going on there. You have a brain that is not fully developed into adulthood. You have a genetic disposition for schizophrenia and a number of possible epigenetic factors that could trigger the illness - anything from trauma to hallucinogens. For whatever reason it does tend to get switched on in late adolescence to early adulthood. My uncle was 19 when he had his first psychotic break, though his siblings have described him as being bizarre throughout his entire childhood.
I have a second family member who was diagnosed at age 20 after experimenting with drugs.
My mother, sister of the uncle with schizoaffective disorder, herself first exhibited symptoms of delusional disorder in her early twenties after a series of traumatic events.
My Aunt, sister of both, was recently encouraged to try a treatment for depression using small doses of ketamine. She asked us whether it was safe for her to do so given her advanced age and the genetic predisposition toward psychosis. The simple truth is that most people don’t start taking hallucinogenics for the first time in their late 50s, so we don’t have a ton of research on people like her. She has to make her own decision, but personally I wouldn’t do it.
I’m not sure this says anything about the OP (based on a quick skim). It’s simply saying there are more older people with schizophrenia (which given the aging population seems a very obvious eventuality) not that people are being diagnosed with schizophrenia at older age (those older people who have schizophrenia now were presumably still diagnosed when they were young)
Though if I remember from the (much more accurate) book he was still diagnosed pretty late in life, this and the fact he to some degree “got better” led some to state he actually had some other mental illness, not schizophrenia.
I’d take the conclusions of that article with a grain of salt. When an elderly person has new onset of hallucinations and psychoses, it’s highly unlikely to be due to schizophrenia. It’s a lot more likely that such symptoms are due to dementia with psychosis, or as a complication of some other underlying medical condition. Treatment with antipsychotics in this type of situation is relatively contraindicated due to increased overall risk of mortality. All antipsychotics carry a black box warning for use in the elderly. None the less, sometimes antipsychotics are the only option. Due to that, there was previously a tendency to document a diagnosis of schizophrenia rather than dementia with psychosis or depression with psychosis since those meds are not contraindicated for schizophrenia, even though that wasn’t the actual underlying disease process. These days that sort of thing is tightly monitored, and nursing homes with high numbers of patients on antipsychotics for a diagnosis of schizophrenia is going to raise red flags with CMS and JCAHO.
ETA. In my personal experience, documenting a diagnosis of schizophrenia for an elderly patient requires documentation that they have had the disease since they were a young adult.
The only person I peripherally knew about - from some association with my wife’s work - apparently it turned out had episodic problems every few months to years. He’d find a place, settle down, get established at some minimum wage job, then suddenly up and vanish, to be found halfway across the country. Where it would happen all over again, rinse and repeat. Until he killed someone during one of these episodes, due to hallucinations or delusions.
Another fellow I knew simply went steadily downhill, not sure why and never looked into the details. At one point he was married, had a kid, next time I saw him he was disheveled and missing teeth. This was in the late 1970’s, so before it could be blamed on oxy or meth.
It seems to me from what I’ve seen that it’s much like migraines and several other situations, where something builds in the brain or chemistry until it snaps and then works itself out in time to build for the next one.
Though in answer to the OP, I think the main meaning behind the statement is that schizophrenia develops early, and is serious enough that someone with it is very unlikely to go undiagnosed. Its not the kind of thing where you can ignore it for years, apparently lead a normal life, until it finally catches up with you and you get a diagnosis and treatment in middle age.
By convention, the geriatric population is considered to include those aged 65 and older. However, the terms “later life” or “late onset” have come to represent, different agegroups when discussing schizophrenia. Late-life schizophrenia comprises two distinct, groups: those individuals who were diagnosed with schizophrenia early in life (late adolescence or young adulthood) and who are now middle-aged; and those who are diagnosed when they are elderly (45 years or older). Those individuals who are diagnosed with schizophrenia at the age of 45 or older are classified as late-onset schizophrenia. Our center has included both middle-aged and elderly persons with schizophrenia, those with early or late onset.
So this statement about number of the equivalent number of people over 65 as 30-44 includes both those who got it at a younger age and still have it as well as those who got it later in life. Later on it states,
Since the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R), “lateonset” schizophrenia has been defined as onset of symptoms after the age of 44,3 and accounts for approximately 15% to 20% of all cases of schizophrenia.
So late onset is still the exception rather than the rule, but not vanishingly small. As to whether this makes the statement in the thread title an “old wives tale”? That’s a judgement call based on how you parse the phrase “most likely never will”.
Actually , I think the reason it is always almost stated as " If you have no signs of schizophrenia by age 30," rather than “if you haven’t been diagnosed by age 30” is because although you are correct that it’s not the sort of thing where you can lead a normal life for years until it catches up with you , it is not terribly uncommon for someone to have symptoms for years and not have been diagnosed either because they don’t encounter medical professionals or because the symptoms were non-specific and/or didn’t meet the diagnostic criteria. When someone is diagnosed with schizophrenia after a psychotic episode at age 40 , if they have been having intermittent delusions and became socially isolated in their 20s that person didn’t suddenly develop schizophrenia at 40.The signs began in his 20s and he was in the prodromal phase starting then but that can only be known in retrospect.
I think the actual meaning of the quoted phrase is a very weak and perhaps trivial statement. It’s generally true of humans that we most likely never will develop schizophrenia. The vast majority subset of us that is left if you exclude people who developed it by 30, obviously, will also most likely never develop it.
A stronger statement would be “most people who develop schizophrenia at some point in their lifetime do so before 30”. This actually means something substantial. Contrast it with the no doubt incorrect statement that “most people who develop Alzheimer’s at some point in their lifetime do so before 30”.
I think this stronger statement might be what is meant to be conveyed (but actually isn’t). People who are particularly worried about developing Schizophrenia might take some comfort reaching 30 without having developed it.
Many people are born with no innate schizophrenia time bomb.
and
Some people are born with the inner schizophrenia time bomb, and it goes off because of trauma, hormones, something and they become schizophrenic.
and
Some people are born with the inner schizophrenia time bomb, but they have lived a blessed life thus far - no trauma, no major stress - and hence just haven’t detonated yet.
and
Some people are born with the inner schizophrenia time bomb but as they reached age 30 their brain gradually “hardened” as protection against the bomb and now it’s unlikely that anything, save for the most drastic trauma, will set off the bomb and make them develop the disorder.
So the aphorism is usually a reference to Category-4, that if you can last all the way til thirty without it, you probably have developed some defense with a mature frontal lobe, cortex, whatever?
I think @Napier really nailed it. What the aphorism means, and what the aphorism literally says by the dictionary definition of its words, are different. Because the morons who wrote the aphorism & popularized it didn’t actually understand how to write unambiguous sentences that actually mean what they actually say. And they were trying to convert a rather complicated clinical and statistical picture into a yes/no sound bite. With consequent loss of nuance and accuracy.
My bottom line: You’re over 30 and you don’t have overt schizophrenia? If so, then you’re virtually assured of not getting it later. Whether that’s because you’re category 1 or category 3 or category 4 doesn’t matter to you. Nor is there any way for you to know which category you’re in.
Only if you’re category 3 and subsequently get very unlucky will you develop the overt disease. Clearly trying hard to manage your life so as to avoid situations tending towards that bad luck will reduce your odds of a problem if you are a category 3 person. But will be useless / unnecessary vis-a-vis schizophrenia if you’re actually category 1 or 4. Though they might still make for a happier life overall.
IMO that’s what it means. And that opinion is worth every penny you paid for it.
I don’t think there is any evidence for this. Its simply that schizophrenia usually develops before 30. There is some evidence that certain things, like drugs or trauma, can cause symptoms to occur earlier, but on the whole there is no causal link to any environmental factor (statistically someone who starts getting schizophrenic symptoms aged 18 after trying marijuana would still almost certainly have got schizophrenic symptoms before the were 30 without any environmental factors.)
It not that something happens at 30 that makes it less likely. An analogy would be saying Covid usually develops less than 2 weeks after exposure, if you are exposed to it 2 weeks ago and you haven’t had it yet, you probably won’t get it (from that exposure), not because your body has hardened after two weeks, its just that is how long it takes symptoms to appear.
Its probably true of other mental illnesses as well, but the seriousness of their symptoms (compared to schizophrenia, which is truly awful) mean its possible to have them and not accept they are actually symptoms of mental illness (I’m just “melancholy”, he had mood swings, etc.), that is not possible for schizophrenia, you know something is wrong with your brain if you have schizophrenia, there is no “mild schizophrenia”.
