Mary V. Seeman, MD, Professor emerita, Department of psychiatry, University of Toronto
Psychoses of unknown cause usually begin in late adolescence or early adulthood. Less frequently the onset occurs in later adulthood (age ≥40). Late-onset psychosis is much more prevalent in women than in men for reasons that are imperfectly understood.
When you are evaluating a midlife woman with first onset of psychosis, don’t assume an illness of unknown cause (bipolar disorder or schizophrenia) until after you have done a comprehensive search for triggers of her psychotic symptoms. After age 40, women are more likely than men to develop psychosis because of gender-specific medical and psychological precipitants.
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