Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-20T07:03:40.222Z Has data issue: false hasContentIssue false
  • English
  • Français

Phenomenology, demography and diagnosis in late paraphrenia

Published online by Cambridge University Press:  09 July 2009

Robert Howard ,
Osvaldo Almeida  and
Raymond Levy
Robert Howard*
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
Osvaldo Almeida
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
Raymond Levy
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
*
1 Address for correspondence: Dr Robert Howard, Section of Old Age Psychiatry, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Get access Rights & Permissions [Opens in a new window]

Synopsis

One hundred and one patients with late paraphrenia were examined using the Present State Examination. The established high prevalence rates of female gender, the unmarried state and sensory impairment were confirmed. All of the symptoms of schizophrenia, with the exception of formal thought disorder, were found in the subjects with approximately the same prevalence as reported in schizophrenics with a symptom onset in younger life. The presence of visual hallucinosis was significantly associated with visual impairment, but the same association was not found between auditory hallucinations and deafness. Mean age at onset of symptoms was high at 74·1 years. Using ICD-10 diagnostic criteria the patients were categorized as schizophrenia (61·4%), delusional disorder (30·7%) and schizoaffective disorder (7·9%). Patients in these diagnostic categories differed in their pre-morbid IQ estimations, current cognitive state measured by the Mini-Mental State Examination and in the number of scored positive psychotic PSE symptoms and their systematization of and preoccupation with delusions and hallucinations. There were no significant differences between the patients in the ICD-10 schizophrenia and delusional disorder groups in terms of age at symptom onset, sex ratio, response to treatment, being unmarried, the presence of insight or sensory impairment. The high degree of clinical similarity between patients with late paraphrenia combined with the inability of ICD-10 to define diagnostic subgroups that correspond to patient clusters derived from clinical symptoms or which are meaningfully different from each other in terms of demographic and prognostic factors provide a strong argument for the retention of late paraphrenia as the most appropriate diagnosis for such patients.

Type
Original Articles
Information
Psychological Medicine , Volume 24 , Issue 2 , May 1994 , pp. 397 - 410
Copyright
Copyright © Cambridge University Press 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Almeida, O., Howard, R., Forstl, H. & Levy, R. (1992). Should the diagnosis of late paraphrenia be abandoned? Psychological Medicine 11, 11–14.CrossRefGoogle Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. Revised. A. P. A.: Washington.Google Scholar
Bland, R. & Orn, H. (1980). Schizophrenia: Schneider's first rank symptoms and outcome. British Journal of Psychiatry 137, 63–68.CrossRefGoogle ScholarPubMed
Bleuler, M. (1943). Die spätschizophrenen Krankheitsbilder (Late schizophrenia clinical picture). Fortschritte der Neurologie Psychiatrie 15, 259–290.Google Scholar
Breitner, J., Husain, M., Krishnan, K., Figiel, G. & Boyko, O. (1990). Cerebral white matter disease in late-onset paranoid psychosis. Biological Psychiatry 28, 266–274.CrossRefGoogle ScholarPubMed
Carpenter, W. & Strauss, J. (1974). Cross-cultural evaluation of Schneider's first rank symptoms of schizophrenia. American Journal of Psychiatry 131, 682–687.CrossRefGoogle ScholarPubMed
Carpenter, W., Strauss, J. & Muleh, S. (1973). Are there path-ognomonic symptoms of schizophrenia? Archives of General Psychiatry 28, 847–852.CrossRefGoogle ScholarPubMed
Castle, D. & Howard, R. (1992). What do we know about the aetiology of late-onset schizophrenia? European Psychiatry 7, 99–108.CrossRefGoogle Scholar
Castle, D. & Murray, R. (1991). The neurodevelopmental basis of sex differences in schizophrenia. Psychological Medicine 21, 565–575.CrossRefGoogle ScholarPubMed
Castle, D., Wessely, S., Der, G. & Murray, R. (1991). The incidence of operationally defined schizophrenia in Camberwell, 1965 to 1984. British Journal of Psychiatry 159, 790–794.CrossRefGoogle Scholar
Cooper, A. (1976). Deafness and psychiatric illness. British Journal of Psychiatry 151, 813–817.Google Scholar
Cooper, A. & Curry, A. (1976). The pathology of deafness in the paranoid and affective psychoses of later life. Journal of Psychosomatic Research 20, 97–105.CrossRefGoogle ScholarPubMed
Cooper, A. & Porter, R. (1976). Visual acuity and ocular pathology in the paranoid and affective psychoses of later life. Journal of Psychosomatic Research 20, 107–114.CrossRefGoogle ScholarPubMed
Cooper, A., Kay, D., Curry, A., Garside, R. & Roth, M. (1974). Hearing loss in the paranoid and affective psychoses of the elderly. Lancet ii, 851–854.CrossRefGoogle Scholar
Corbin, S. & Eastwood, M. (1986). Sensory deficits and mental disorders of old age: causal or coincidental associations? Psychological Medicine 16, 251–256.CrossRefGoogle ScholarPubMed
Fish, F. (1960). Senile schizophrenia. Journal of Mental Science 106, 938–946.CrossRefGoogle ScholarPubMed
Flint, A., Rifat, S. & Eastwood, M. (1991). Late-onset paranoia: distinct from paraphrenia? International Journal of Geriatric Psychiatry 6, 103–109.CrossRefGoogle Scholar
Folstein, M., Folstein, S. – McHugh, P. (1975). ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Gabriel, E. (1978). Die Langfristige Entwicklung der Spätschizophrenien. Karger: Basel.Google Scholar
Grahame, P. (1984). Schizophrenia in old age (late paraphrenia). British Journal of Psychiatry 145, 493–495.CrossRefGoogle ScholarPubMed
Häfner, H., Behrens, S., De Vry, J. & Gattaz, W. (1991). An animal model for the effects of estradiol on dopamine-mediated behaviour: implications for sex differences in schizophrenia. Psychiatry Research 38, 125–134.Google Scholar
Hamilton, M. (1984). Fish's Schizophrenia. Wright: London.Google Scholar
Harris, M. & Jeste, D. (1988). Late-onset schizophrenia: an overview. Schizophrenia Bulletin 14, 39–55.CrossRefGoogle ScholarPubMed
Herbert, M. & Jacobson, S. (1967). Late paraphrenia. British Journal of Psychiatry 113, 461–469.CrossRefGoogle ScholarPubMed
Holden, N. (1987). Late paraphrenia or the paraphrenias? A descriptive study with a 10-year follow-up. British Journal of Psychiatry 150, 635–639.CrossRefGoogle ScholarPubMed
Howard, R. & Levy, R. (1992). Which factors affect treatment response in late paraphrenia? International Journal of Geriatric Psychiatry 7, 667–672.CrossRefGoogle Scholar
Howard, R., Forstl, H., Almeida, O., Burns, A. & Levy, R. (1992 a). Computer-assisted CT measurements in late paraphrenics with and without Schneiderian first rank symptoms: a preliminary report. International Journal of Geriatric Psychiatry 7, 35–38.CrossRefGoogle Scholar
Howard, R., Forstl, H., Naguib, M., Burns, A. & Levy, R. (1992 b). First rank symptoms of Schneider in late paraphrenia. Cortical structural correlates. British Journal of Psychiatry 160, 108–109.CrossRefGoogle ScholarPubMed
Howard, R., Castle, D., O'Brien, J., Almeida, O. & Levy, R. (1992 c). Permeable walls, floors, ceilings and doors. Partition delusions in late paraphrenia. International Journal of Geriatric Psychiatry 7, 719–724.CrossRefGoogle Scholar
Howard, R., Castle, D., Wessely, S. & Murray, R. (1993). A comparative study of 470 cases of early and late-onset schizophrenia. British Journal of Psychiatry 163, 352–357.CrossRefGoogle ScholarPubMed
Hymas, N., Naguib, M. & Levy, R. (1989). Late paraphrenia. A follow-up study. International Journal of Geriatric Psychiatry 4, 23–29.CrossRefGoogle Scholar
Jorgensen, P. & Munk-Jorgensen, P. (1985). Paranoid psychosis in the elderly: a follow-up study. Acta Psychiatrica Scandinavica 72, 358–363.CrossRefGoogle ScholarPubMed
Kay, D. & Roth, M. (1961). Environmental and hereditary factors in the schizophrenias of old age (‘late paraphrenia’) and their bearing on the general problem of causation in schizophrenia. Journal of Mental Science 107, 649–686.CrossRefGoogle ScholarPubMed
Klages, W. (1961). Die Spätschizophrenie. Enke: Stuttgart.Google Scholar
Kraepelin, E. (1913). Psychiatrie, ein Lehrbuch für Studierende und Artze. Barth: Leipzig.Google Scholar
Kraepelin, E. (1919). Dementia Praecox and Paraphrenia. Translated by Barclay, R. M.. Livingstone: Edinburgh.Google Scholar
Marneros, A. & Deister, A. (1984). The psychopathology of ‘late schizophrenia’. Psychopathology 17, 264–274.CrossRefGoogle ScholarPubMed
Mayer, W. (1921). Über paraphrene Psychosen. Zeitschrift für die Gesamte Neurologie und Psychiatrie 71, 187–206.CrossRefGoogle Scholar
Mellor, C. (1970). First-rank symptoms of schizophrenia. British Journal of Psychiatry 117, 15–23.CrossRefGoogle ScholarPubMed
Miller, B., Lesser, I., Boone, K., Hill, E., Mehringer, C. & Wong, K. (1991). Brain lesions and cognitive function in late-life psychosis. British Journal of Psychiatry 158, 76–82.CrossRefGoogle ScholarPubMed
Naguib, M. & Levy, R. (1987). Late paraphrenia: neuropsychological impairment and structural brain abnormalities on computed tomography. International Journal of Geriatric Psychiatry 2, 83–90.CrossRefGoogle Scholar
Nelson, H. E. (1982). The National Adult Reading Test. NFER-Nelson: Windsor.Google Scholar
Norusis, M. (1990). SPSS/PC+ Statistics 4·0 for the IBM PC/XT/AT and PS/2. SPSS International BV: PO Box 115, 4200 AC Gorinchem, The Netherlands.Google Scholar
Pearlson, G. & Rabins, P. (1988). The late-onset psychoses: possible risk factors. Psychiatric Clinics of North America 11, 15–33.CrossRefGoogle ScholarPubMed
Pearlson, G., Kreger, L., Rabins, P., Chase, G., Cohen, B., Wirth, J., Schlaepfer, T. & Tune, L. (1989). A chart review study of late-onset and early-onset schizophrenia. American Journal of Psychiatry 146, 1568–1574.Google ScholarPubMed
Post, F. (1966). Persistent Persecutory States of the Elderly. Pergamon: Oxford.Google Scholar
Quintal, M., Day-Cody, D. & Levy, R. (1991). Late paraphrenia and ICD-10. International Journal of Geriatric Psychiatry 6, 111–116.CrossRefGoogle Scholar
Rabins, P., Pearlson, G., Jayaram, G., Steele, C. & Tune, L. (1987). Ventricle-to-brain ratio in late-onset schizophrenia. American Journal of Psychiatry 144, 1216–1218.Google ScholarPubMed
Rokhlina, M. (1975). A comparative clinico-genetic study of attack-like schizophrenia with late and early manifestations with regard to age. Zhurnal Nevropatologii i Psiikhiatrii Imenii S. S. Korsakova 75, 417–424.Google ScholarPubMed
Roth, M. & Morrisey, J. (1952). Problems in the diagnosis and classification of mental disorders in old age. Journal of Mental Science 98, 66–80.CrossRefGoogle Scholar
Roth, M., Huppert, F., Tym, E. & Mountjoy, C. (1988). CAMDEX. The Cambridge Examination for Mental Disorders of the Elderly. Cambridge University Press: Cambridge.Google Scholar
Schneider, C. (1930). Die Psychologie der Schizophrenen. Thieme: Leipzig.Google Scholar
Seeman, M. (1982). Gender differences in schizophrenia. Canadian Journal of Psychiatry 27, 107–111.CrossRefGoogle ScholarPubMed
Siegel, E. & Rollberg, I. (1970). Über Spätschizophrenien. Wiener Zeitschrift für Nervenheilkunde und deren Grenzgebieke 28, 145–151.Google Scholar
Steinberg, E. (1972). Neuere Forschungsergebnisse bei spätschizophrenen Psychosen. Fortschritte der Neurologie Psychiatrie 40, 631–646.Google Scholar
Wing, J. & Hailey, A. (1972). Evaluating a Community Psychiatric Service: The Camberwell Register, 1964–1971. Cambridge University Press: Cambridge.Google Scholar
Wing, J., Cooper, J. & Sartorius, N. (1974). Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar
World Health Organization (1967). Glossary of Mental Disorders and Guide to their Classification for Use in Conjunction with the International Classification of Diseases, 8th Revision. WHO: Geneva.Google Scholar
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. WHO: Geneva.Google Scholar