Late paraphrenia revisited

The pathology of paraphrenia

The term paraphrenia refers to a condition characterized by a strong delusional component with preservation of thought and personality. Most affected patients are women. Although a late age at onset (> 60 years) has been proposed in the literature, evidence for this assertion remains debatable. Deterioration of cognitive functions occurs very slowly but may lead to mild dementia over a period of years. Pathological studies indicate the presence of neurofibrillary tangles (NFTs), primarily within the entorhinal cortex. Compared with the severity of neuritic changes, amyloid deposition remains scant. Pyramidal cells affected by NFTs appear to be preserved. Both the clinical history and neuropathology of paraphrenia are similar to those aspects described for NFT-predominant senile dementia. Risk factors, including organic lesions, may precipitate an earlier onset of symptomatology in patients exhibiting this pathology. Many of the symptoms in paraphrenia can be explained by involvement of the entorhinal cortex.

Goals of inpatient treatment for psychiatric disorders

The purpose of the psychiatric hospital changed dramatically during the twentieth century. Formerly the primary location for psychiatric treatment, the hospital now plays a more circumscribed role within a community-based system of care. Crisis stabilization, safety, and a focus on rapid discharge are the critical components of the acute inpatient stay. Subspecialized units focus on geriatrics, children, adolescents, dual diagnosis (substance abuse and mental illness), trauma disorders, eating disorders, and forensics. When integrated with the general medical system and a comprehensive base of community-delivered day treatment, residential services, and outpatient services, psychiatric hospitalization is a humane alternative to long-term institutional care.

A descriptive study of first presentation psychosis in old age

OBJECTIVE

This report describes the characteristics of a sample of elderly subjects presenting with their first episode of psychosis in old age.

METHOD

Forty-six (38 females and eight males) patients were assessed on a variety of cognitive, psychopathological and personality measures.

RESULTS

Female preponderance, social isolation and early cognitive deficits were findings of this study which have been replicated by other studies of late-onset psychosis. In contrast, hearing loss was not overly represented in this sample. Personality style differed significantly from accepted norms of adult personality traits, with lower scores for dimensional ratings of neuroticism, extraversion and openness to change.

CONCLUSIONS

The descriptive findings in this study suggest that psychosocial factors require further investigation in patients presenting with late-onset psychosis. Comparison with younger first-onset psychotic subjects will be the subject of a later report.

Late paraphrenia: a variant of schizophrenia manifest in late life or an organic clinical syndrome? A review of recent evidence

A large amount of research has been devoted during the past 15 years to the clinical and neurobiological aspects of the disorder named as 'late paraphrenia' (LP) in 1955. The symptomatology and diagnosis of the disorder, its prognosis, the cognitive functioning of those affected, the structural changes in the brain as revealed by modern techniques of brain imaging and its postmortem neuropathology have all been submitted to investigation. The results have been widely regarded as consistent with the concept of LP as an organic disease of the brain, but increased knowledge of the neurobiology of schizophrenia and of the age-related changes that occur in the brains of elderly people casts doubt on the validity of this interpretation. The findings are consistent with the view that LP is the form in which schizophrenia is manifest in old age. The proposal that LP has a closer kinship with affective disorder than with schizophrenia is part of a general theory of the sex differences in schizophrenia. In LP it becomes entangled with the organicity hypothesis, suggesting that neither of these explanations is adequate, and most of the evidence points to a unitary concept which views LP as a variant of a single disorder, namely schizophrenia, which, however, requires a broad definition. This concept has implications for fresh paths of enquiry.