Paraphrenia

Introduction

Paraphrenia was introduced as a distinct condition by Emil Kraepelin (1921) early in the twentieth century and he described it as a functional psychotic disorder which was separate from both schizophrenia and paranoia. Paraphrenia suffered a similar fate to paranoia as the definition of schizophrenia later began to widen, and eventually most cases were probably diagnosed as paranoid schizophrenia or, as now seems to be becoming more common, schizoaffective disorder. Paranoia, as we have seen, has re-emerged since DSMIIIR (1987) in recent years as a diagnosis in its own right, although re-named delusional disorder. Paraphrenia is currently excluded from the principal diagnostic classificatory systems, but still has a shadowy existence on the edge of our psychiatric nosology.

This chapter aims to demonstrate that paraphrenia is at the very least a sub-category of psychiatric illness whose diagnosis is of practical value, and that it may possibly even be a separate diagnostic entity. Of late, psychiatrists appear to have become increasingly unwilling to diagnose schizophrenia when there are significantly atypical features present but, as will be noted, there is often no satisfactory alternative diagnostic category for cases like this. In fact, some of these ‘atypical’ patients' illnesses accord well with the description of paraphrenia, particularly when the latter is modified in terms of modern concepts and practices (see later).