Background and Hypothesis The onset of schizophrenia occurs after the age of 40 in up to 20% of cases. We aim to depict risk factors for first-episode psychosis after the age of 40 by comparing late-onset psychosis (LOP) patients to healthy age-matched controls. Study Design In this case-control study using electronic health records, 142 individuals aged 40–65 years with an encounter for a first episode of psychosis between 2013 and 2021 were included. Four controls (N = 568) were matched to each case on age, sex, race, and year of encounter. Potential risk factors for the primary analysis were captured via structured data and text-mining of medical notes. Conditional logistic regression models were used to assess the odds of LOP with potential risk factors. Study Results After adjusting for all variables in the main analysis, odds for LOP were increased by immigration (OR 3.30, 95% CI, 1.56–6.98), depression (OR 3.58, 95% CI, 2.01–6.38), anxiety (OR 2.12, 95% CI, 1.20–3.75), cannabis use (OR 3.00, 95% CI, 1.36–6.61), alcohol use disorder (OR 5.46, 95% CI, 2.41–12.36), polysubstance use (OR 4.22, 95% CI, 1.30–13.7), severe trauma (OR 2.29, 95% CI, 1.08–4.48), and caregiver burden (OR 15.26, 95% CI, 3.85–60.48). Conclusions Life stressors along with the effects of substance use and other psychiatric conditions may confer some risk to the development of LOP. Replication is required in independent prospective studies. Further research is necessary to truly parse out which of these factors belong on the causal pathway.

中文翻译：

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迟发性精神病的危险因素：一项病例对照研究


背景和假设 精神分裂症的发作发生在 40 岁之后，高达 20% 的病例。我们的目标是通过将晚发性精神病 （LOP） 患者与健康年龄匹配的对照进行比较，来描述 40 岁后首发精神病的危险因素。研究设计 在这项使用电子健康记录的病例对照研究中，纳入了 142 名年龄在 40-65 岁之间，在 2013 年至 2021 年间首次经历精神病发作的个体。四个对照 （N = 568） 与年龄、性别、种族和相遇年份的每个病例相匹配。通过结构化数据和医疗记录的文本挖掘来捕获初步分析的潜在风险因素。使用条件 logistic 回归模型评估具有潜在危险因素的 LOP 几率。研究结果在调整了主要分析中的所有变量后，移民（OR 3.30,95% CI，1.56-6.98）、抑郁（OR 3.58,95% CI，2.01-6.38）、焦虑（OR 2.12,95% CI，1.20-3.75）、大麻使用（OR 3.00,95% CI，1.36-6.61）、酒精使用障碍（OR 5.46,95% CI，2.41-12.36）、多物质使用（OR 4.22、 95% CI，1.30-13.7）、严重创伤（OR 2.29,95% CI，1.08-4.48）和护理人员负担（OR 15.26,95% CI，3.85-60.48）。结论 生活压力源以及物质使用和其他精神疾病的影响可能会给 LOP 的发展带来一些风险。在独立的前瞻性研究中需要复制。需要进一步的研究才能真正解析出这些因素中的哪些属于因果途径。