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Psychotic States Arising in Late Life (Late Paraphrenia)

The Role of Risk Factors

Published online by Cambridge University Press:  02 January 2018

Osvaldo P. Almeida ,
Robert J. Howard ,
Raymond Levy  and
Anthony S. David
Osvaldo P. Almeida*
Affiliation:
Departamento de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Brazil
Robert J. Howard
Affiliation:
Institute of Psychiatry, Denmark Hill, London
Raymond Levy
Affiliation:
Institute of Psychiatry, Denmark Hill, London
Anthony S. David
Affiliation:
Institute of Psychiatry, Denmark Hill, London
*
Professor Almeida, Departamento de Psiquiatria, Faculdade de Medicina da Universidade de Söo Paulo, Rua Dr. Ovidio Pires de Campos S/N, CEP.05403-010, Caixa Postal 8091, São Paulo/SP, Brazil
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Abstract

Background

This study explored the association between ‘late paraphrenia’ and various risk factors such as female gender, sensory impairment, marital status, positive family history of psychoses, and the presence of abnormal neurological signs. It was hypothesised that patients would show significantly more abnormal neurological signs than controls.

Method

Inclusion criteria for the diagnosis of late paraphrenia were fulfilled by 47 patients, including in-patients, out-patients, day-patients, and those living in the community. Thirty-three age-, sex-, education-, and premorbid IQ-matched elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK). A scale for the assessment of neurological soft and hard signs was developed for this study. The Abnormal Involuntary Movement Scale (AIMS) and the Tardive Dyskinesia Rating Scale (TDRS) were also used.

Results

There was a high female-to-male ratio (42:5), and a fourfold increase in the risk of patients having hearing impairment (odds ratio = 4.15, Clodds = 1.36 to 12.63). There was no difference between the two groups in visual difficulties nor in marital status. Patients were approximately ten times more likely to be living on their own (odds ratio = 10.61; Clodds = 3.59 to 31.33) and 16 times more likely to be considered socially isolated (odds ratio = 16.65; Clodds = 5.39 to 51.40). There was no difference between patients and controls in frequency of schizophrenia-like family history. Patients were more likely than controls to exhibit neurological soft signs (z = 4.70; P < 0.001; Cld = 4.61 to 9.63). The presence of abnormal involuntary and tardive dyskinesia movements was associated with the use of antipsychotic medication.

Conclusion

Women appear to run a greater risk of developing late paraphrenia, especially those who are socially isolated and present with associated hearing impairment. The increased presence of neurological soft signs among patients indicates that brain disease may be a critical factor in the development of psychotic symptoms in late life.

Type
Papers
Information
The British Journal of Psychiatry , Volume 166 , Issue 2 , February 1995 , pp. 215 - 228
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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