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Reduction of the rising costs of health care is also possible, and prevention is the way to do so. Research has shown that depression raises the cost of medical care in older adults significantly; yet, it is usually treatable and sometimes preventable. For example, focus on methods for early detection and treatment or even prevention of a depressive episode that commonly follows heart attack or stroke.
Late-onset schizophrenia is not something we read about often. The perception is that schizophrenia hits in the late teens or 20s. Can you talk more about that?
Jeste: Schizophrenia is usually thought to have its onset in early life—usually in the teens or 20s. However, we and several other research groups have found that approximately 20 percent of people with schizophrenia first manifest their illness after the age of 40. The symptoms, course and treatment response in this late-onset schizophrenia are largely similar to those in earlier-onset schizophrenia. However, there also are some differences. For example, late-onset schizophrenia is usually of paranoid type and is much more common among women (mostly post-menopausal) than in men—just opposite of earlier-onset schizophrenia. There is also a greater prevalence of hearing loss and vision problems in late-onset schizophrenia; on the other hand, late-onset schizophrenia tends to have better prognosis and the treatment involves lower daily dosages of antipsychotics than those necessary to treat earlier-onset schizophrenia.
You co-authored a book on Tardive Dyskinesia. Are there truly any treatments for this side effect?
Jeste: Neuroleptic-induced tardive dyskinesia is one of the most serious adverse effects of prolonged use of typical or conventional antipsychotics such as haloperidol and fluphenazine. Despite the efforts of researchers, as yet there appear to be no consistently reliable therapy for this syndrome, which is potentially persistent and sometimes irreversible. A number of treatments such as vitamin E have been reported to work in some patients, but the best treatment is discontinuation of the typical antipsychotics, when it is feasible. Fortunately, the newer atypical antipsychotics are much less likely to cause TD than the older typical antipsychotics. Of course, long-term use of atypical antipsychotics is associated with a different set of side effects such as weight gain and diabetes.
What are your plans for your future work?
Jeste: As mentioned above, in recent years, I have been studying successful aging and wisdom in the population at large. My plan is to expand this work to people with serious mental illness. Little is known about the rate of successful aging in persons with severe illnesses. We have recently begun separate research studies on successful aging in people with schizophrenia and those infected with HIV. Our hope is that understanding factors that promote successful aging at an individual level would lead to the development of new preventive and therapeutic interventions aimed at improving quality of life and well-being in older adults living with chronic illness.
I would like to focus on reducing the social stigma associated with old age as well as mental illness. This can be done, in part, by showing positive outcomes of both (i.e., successful aging in people with mental illness). I believe that adequate attention has not been paid to positive psychological factors such as resilience, optimism, social engagement and wisdom. I would like to develop interventions to enhance these positive traits in people with mental illness with the goal of hastening and sustaining their recovery. This is what I call Positive Psychiatry.
I also look forward to continuing my work with NAMI, the largest and most influential mental health advocacy group in the U.S. as well as the world. I have had the pleasure and privilege of collaborating with NAMI both at national and local levels over a long time. I hope to increase that partnership in the years to come.
Dr. Jeste earned his medical degree in Pune, India, and trained in psychiatry in Mumbai, India. After coming to the U.S., he completed his psychiatry residency at Cornell University and his neurology residency at George Washington University. He was a research fellow as well as Chief of the Units on Movement Disorders and Dementias at the National Institute of Mental Health. After joining the UC San Diego School of Medicine, Dr. Jeste developed an NIMH-funded Geriatric Psychiatry Clinical Research Center. He serves as editor-in-chief at the American Journal of Geriatric Psychiatry. To learn more on wisdom, read Dr. Jeste’s article in the Journal of the American Medical Association. Dr. Jeste will speak at the 2013 NAMI National Convention in San Antonio during the Research Plenary on Sunday, June 30.