[Verse 1]
When schizophrenia travels through the decades of a life,
The hallucinations soften, fewer visions sharp as knives,
Yet the negative symptoms hold their ground like ancient stone,
Flat affect and alogia, cognitive deficits enthroned,
Medical comorbidity compounds what time has worn,
Premature mortality, a statistic we must mourn,
The positive may quiet, but the burden carries on,
We tend to what remains when the louder voices gone
[Chorus]
Late-onset, very-late, secondary, or lifelong —
Sensory deficits, isolation feeding what goes wrong,
CBSST and FAST, the skills to fortify the day,
Delusional disorder, Charles Bonnet on display,
Name the cause, assess the context, parse each symptom's root,
Know the type, select the treatment, trace it to the fruit
[Verse 2]
When psychosis first emerges past the age of forty years,
We call it late-onset schizophrenia, note the gender skew appears,
Women predominate where isolation carved the space,
Sensory deficits in hearing, vision — symptoms misplace,
Very-late-onset past sixty, paranoia through the wall,
A neighbor pilfering, a conspiracy down the hall,
Not a lifelong illness but a late and novel guest,
Distinct etiology demanding different tests
[Chorus]
Late-onset, very-late, secondary, or lifelong —
Sensory deficits, isolation feeding what goes wrong,
CBSST and FAST, the skills to fortify the day,
Delusional disorder, Charles Bonnet on display,
Name the cause, assess the context, parse each symptom's root,
Know the type, select the treatment, trace it to the fruit
[Verse 3]
When dementia, delirium, Parkinson's, or pills
Generate a psychosis wrapped in secondary ills,
The primary culprit hides beneath the symptom's face,
Treat the underlying driver or you're losing in the race,
Depression too can summon visions grim and hollow-toned,
Somatic and persecutory delusions firmly honed,
But Charles Bonnet stands peculiar — macular degeneration's art,
Rich visual hallucinations, insight wholly intact
[Bridge]
There's an elderly woman who sees children on her chair,
She knows they are not present, she can tell you they're not there,
Her retina is failing, but her cognition holds firm ground,
Charles Bonnet, not psychosis — in the diagnosis found,
No antipsychotic needed for the visions she perceives,
Reassurance and explanation grant the patient some reprieve
[Chorus]
Late-onset, very-late, secondary, or lifelong —
Sensory deficits, isolation feeding what goes wrong,
CBSST and FAST, the skills to fortify the day,
Delusional disorder, Charles Bonnet on display,
Name the cause, assess the context, parse each symptom's root,
Know the type, select the treatment, trace it to the fruit