Late paraphrenia — a follow‐up study

Abstract

We report a 3.7 year follow-up study carried out on 42 patients with an original diagnosis of late paraphrenia who had had a CT scan and simple tests of cognition in addition to an assessment by means of the Geriatric Mental State Schedule. Mortality was found to be no different than in a control group. Patients showed improvement in target symptoms but exhibited a good deal of residual morbidity, particularly of motor and cognitive function. Cognitive performance, which was previously mildly impaired, showed some futher deterioration, usually falling short of clear-cut dementia. Ventricular size on the CT scan was not a predictor of outcome. The article highlights the organic substrate of late paraphrenia but suggests that the cerebral changes are relatively subtle and slowly progressive.K E Y wow-Paraphrenia, follow-up study.Requests for reprints: Section of Old Age Psychiatry,

Should the diagnosis of late paraphrenia be abandoned?

“…Naguib & Levy (1987) used the Mental Test Score and Digit Copying test to evaluate 43 patients. They performed significantly worse than age matched controls on these tasks and showed some deterioration in a 3-7-year follow-up study, though their scores remained above the cut-off point for a diagnosis of dementia (Hymas et al 1989). Further examination of this issue is required using more detailed neuropsychological tests and perhaps an even longer period of follow-up.…”

Late-Onset Psychosis; Is It Real?

“…However, only one-quarter of patients were remitted and the remainder had residual psychiatric symptoms for an average 10-year follow-up or at death. 58 Another study found that half of the patients were continuously medicated with antipsychotics, with 60% having resolution of the initial psychotic symptoms after an average of 3.7 years follow-up. 59 Yet another study used Danish case register data to compare the 10-year prognosis of schizophrenia before 40-years-of-age with schizophrenia evident between 40-and 60-years-of-age.…”

“…A certain cutoff Mini-Mental State Examination (MMSE) score or similar neuropsychological test score for inclusion used in many studies have not been strictly comparable. Some studies excluded patients only on the basis of a clinical diagnosis of dementia, 58,60,61,97 while another study did not use any specific exclusion criteria regarding cognitive status. 46 Considering the lack of standardized and validated study design, it is not surprising that cognitive cut-off scores adopted in study populations varied from a MMSE score of 17.6 46 to 28.21.…”

“…58 The authors opined that this was due to the development of new independent cognitive symptoms rather than changing previous diagnosis. Using a retrospective chart review of the patient's clinical status and neuropsychological test score, another study also reported that 35% of patients of new late paraphrenia patients progressed to dementia within three years.…”

Predictive Properties of Referral Communications for Mental Illness and Dementia in a Community

“…Psychiatric diagnosis was established using the DSM-III. The diagnosis of late paraphrenia was based on the criteria by Hymas et al [10].…”