Onset of schizophrenia at 100 years of age
Family members of Mrs. D, a 100-year-old illiterate widow, complained that for the last 9 months she remained fearful and said that someone wanted to kill her and harm her family members. She held that belief firmly, which according to everyone in the family was baseless. She would appear to be muttering abusive words and gesticulating to herself and, on being questioned by family members, she would say that she was reacting to voices of some unknown persons who were discussing about her and were planning to kill her. Her sleep also remained disturbed. There had been no complaint of forgetfulness. She had no significant medical, surgical, or psychiatric illness in the past or any significant family history. She had never used any substance. According to her family, she was an independent, intelligent, and cooperative person.\nOn physical examination, Mrs. D had persistently raised (borderline high) blood pressure (had never been checked earlier). She had kyphosis of spine and walked with the help of a walking stick. Her neuromuscular examination including examination for hearing and vision was within normal limits. On Mini-Mental State Examination (MMSE), she scored 25/27, with points lost for not answering for year and date. Also, reading, writing, and copying the interlocking pentagons could not be done (she had never used a pen). On mental status examination, she was alert and cooperative. She had unshakable belief that there was someone who was after her to kill her. She acknowledged hearing the voices of unknown males for the past few months who discussed among themselves the plan to kill her. She heard those voices through her ears in clear consciousness. She had good immediate, recent, and remote memory and had a good fund of general information and could correctly perform simple verbal calculations. Abstraction and test judgment ability was intact and she had no insight into her psychiatric illness.\nShe was prescribed tablet olanzapine 5 mg at bedtime and slept well in the ward. Her hemogram, renal, hepatic and thyroid function tests, lipid profile, serum electrolytes, and routine urinary examination were within normal range. Her chest roentgenogram and electrocardiogram were normal, echocardiography revealed type I diastolic dysfunction that was age related as per the cardiologist's opinion; magnetic resonance imaging (MRI) of brain revealed generalized age-related cerebral atrophy and electroencephalogram (EEG) was a normal awake record. She was prescribed hydrochlorthiazide 12.5 mg at bedtime by the cardiologist, and her subsequent blood pressure recordings were within normal limits. The dose of olanzapine was increased to 7.5 mg at bedtime on the seventh day. Her suspiciousness, fearfulness, and auditory hallucinations started decreasing in the second week of admission, and she was discharged on the tenth day. She achieved full remission in 3 weeks and is on regular follow-up now. She is maintaining well thereafter until date (more than 10 months).