PSYCHOTIC STATES ARISING IN LATE-LIFE (LATE PARAPHRENIA) PSYCHOPATHOLOGY AND NOSOLOGY

Background. This study explored the psychopathological state of a samp le of 'late paraphrenic' patients and the reliability of their diagnos is according to the most widely used systems of classification of ment al disorders. Method. The presence and severity of psychiatric symptom s were assessed with the Present State Examination (PSE), the Scale fo r the Assessment of Positive Symptoms (SAPS), and the High Royds Evalu ation of Negativity (HEN) scale. Patient signs and symptoms were class ified according to the PSE9-CATEGO4, DSM-III-R, DSM-IV, and ICD-10 dia gnostic systems. Agreement among the 11 most widely used criteria for the diagnosis of schizophrenia was assessed for these patients. These included DSM-III-R, DSM-IV, ICD-10, Schneider, Langfeldt, New Haven Sc hizophrenia Index, Carpenter, Research Diagnostic Criteria (RDC), Feig hner, Taylor and Abrams, and PSE9-CATEGO4. The study assessed 47 patie nts, including in-patients, out-patients, day-patients, and those in t he community. Thirty-three elderly controls were recruited from lunche on clubs in Southwark and Lambeth (London, UK). Results. Patients show ed a wide range of delusional ideas, most frequently involving persecu tion (83.0%) and reference (31.9%). Eighty-three per cent of patients reported some sort of hallucination, most frequently auditory (78.7%). Formal thought disorder was very rare, only one patient,showing mild signs of circumstantial speech. No patients exhibited catatonic sympto ms or inappropriate affect. Shallow, withdrawn, or constricted affect was found in only 8.5% of patients. The various systems of classificat ion indicated that most patients displayed typical schizophrenic sympt oms, although up to one-third of them did not meet criteria for the di agnosis of schizophrenia. There was poor agreement among the different diagnostic schedules as to whether to classify patients as schizophre nic (0.02<k<0.45). Conclusion. Psychotic states arising in late life a re accompanied by various psychiatric symptoms that are not entirely t ypical of early-onset schizophrenia. The current trend to include 'lat e paraphrenia' into the diagnosis of schizophrenia or delusional disor der has poor empirical and theoretical bases.