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SO106

Diagnostic heterogeneity in women with late-onset psychosis: a case series from a first-episode psychosis program

DIAGNOSTIC HETEROGENEITY IN WOMEN WITH LATE-ONSET PSYCHOSIS: A CASE SERIES FROM A FIRST-EPISODE PSYCHOSIS PROGRAM

Diagnoses among women presenting with a first psychotic episode after age 40 are markedly heterogeneous, with six out of ten ultimately receiving mood spectrum diagnoses.

The study aims to describe the clinical characteristics and diagnostic trajectories of women presenting with first-episode psychosis after age 40. The records of women aged 40 and older followed in 2025 at the Early Psychosis Program at Hospital Universitario Son Espases (Spain) were reviewed retrospectively; symptom profiles, mood symptoms, psychosocial stressors, substance use, diagnostic course, and duration of untreated psychosis (DUP) were recorded. Ten women with an age at onset ranging from 40 to 61 were identified. Among cases in which DUP could be estimated, it ranged from approximately 2 weeks to 10 months (the abstract reported a median DUP of 6 months). Final diagnoses comprised psychotic depression (n = 4), bipolar disorder (n = 2), delusional or unspecified presentations (n = 2), schizophreniform disorder (n = 1), and substance-related psychosis (n = 1), with 6 of the 10 cases ultimately receiving a mood spectrum diagnosis. Most cases featured prominent mood symptoms; psychosocial stressors were common, including gender-based violence, bereavement, caregiving burden, work-related stress, family conflict, and major life events. The clinical course varied by diagnosis: among cases of psychotic depression, two achieved full remission with functional recovery, while the others continued to experience residual psychotic symptoms and functional limitations; one of the cases of bipolar disorder improved following electroconvulsive therapy (ECT) but remained dependent on others for daily functioning; the case of schizophreniform disorder achieved full recovery; and both the delusional and unspecified cases showed residual delusions. In conclusion, age at onset alone does not define a distinct clinical entity; a gender-sensitive, longitudinal perspective that considers the mood component, psychosocial stressors, and life-stage-specific biological factors such as the perimenopausal transition together may improve diagnostic formulation.

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