Skip to main content
×
×
Home

Psychotic States Arising in Late Life (Late Paraphrenia): The Role of Risk Factors

  • Osvaldo P. Almeida (a1), Robert J. Howard (a2), Raymond Levy (a2) and Anthony S. David (a2)
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.

Copyright
Corresponding author
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
References
Hide All
Almeida, O. P. (1993) Clinical and Cognitive Diversity of Psychotic States Arising in Late Life (Late Paraphrenia). PhD thesis, University of London.
Almeida, O. P., Howard, R., Förstl, H., et al (1992a) Should the diagnosis of late paraphrenia be abandoned? Psychological Medicine, 22, 1114.
Almeida, O. P., Howard, R., Förstl, H., et al (1992b) Late paraphrenia: a review. International Journal of Geriatric Psychiatry, 7, 543548.
Almeida, O. P., Förstl, H., Howard, R., et al (1993) Unilateral auditory hallucinations. British Journal of Psychiatry, 162, 262264.
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
Andreasen, N. C. (1984) The Scale for the Assessment of Positive Symptoms (SAPS). Iowa City, IA: University of Iowa Press.
Andreasen, N. C. (1990a) Methods for assessing positive and negative symptoms. In Schizophrenia: Positive and Negative Symptoms and Syndromes. Modern Problems in Pharmacopsychiatry, Vol. 24 (ed. Andreasen, N. C.), pp. 7388. Basel: Karger.
Andreasen, N. C. (1990b) Positive and negative symptoms: historical and conceptual aspects. In Schizophrenia: Positive and Negative Symptoms and Syndromes. Modern Problems in Pharmacopsychiatry, Vol. 24 (ed. Andreasen, N. C.), pp. 142. Basel: Karger.
Andreasen, N. C., Flaum, M., Swayze, V. W., et al (1990) Positive and negative symptoms in schizophrenia: a critical appraisal. Archives of General Psychiatry, 47, 615621.
Andreasen, N. C. M. & Swayze, V. W. (1991) Schizophrenia: the characteristic symptoms. Schizophrenia Bulletin, 17, 2749.
Angermeyer, M. C. & Kuhn, L. (1988) Gender differences in age at onset of schizophrenia: an overview. European Archives of Psychiatry and Neurological Sciences, 237, 351364.
Baldwin, R. C. & Jacoby, R. (1991) Affective disorders. In Psychiatry in the Elderly (eds Jacoby, R. & Oppenheimer, C.), pp. 676734. Oxford: Oxford University Press.
Bland, R. C. (1977) Demographic aspects of functional psychoses in Canada. Acta Psychiatrica Scandinavica, 55, 369380.
Blessed, G., Tomlinson, B. E. & Roth, M. (1968) The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. British Journal of Psychiatry, 114, 797811.
Blessed, G. & Wilson, D. (1982) The contemporary natural history of mental disorder in old age. British Journal of Psychiatry, 141, 5967.
Bleuler, M. (1943) Post-mortem findings in late-schizophrenia (partially trans. Förstl, H., Howard, R., Almeida, O. P. & Stadmüller, G. 1992 from “Die spätschizophrenen Krankheitsbilder”, Fortschritte der Neurologie-Psychiatrie, 15, 259290). In Delusions and Hallucinations in Old Age (eds Katona, C. & Levy, R.), pp. 166–167. London: Gaskell.
Bloom, F. E. (1993) Advancing a neurodevelopmental origin for schizophrenia. Archives of General Psychiatry, 50, 224227.
Breitner, J. C. S., Husain, M. M., Figiel, G. S., et al (1990) Cerebral white matter disease in late-onset paranoid psychosis. Biological Psychiatry, 28, 266274.
Burns, A., Carrick, J., Ames, D., et al (1989) The cerebral cortical appearance in late paraphrenia. International Journal of Geriatric Psychiatry, 4, 3134.
Burns, A., Jacoby, R. & Levy, R. (1990) Psychiatric phenomena in Alzheimer's disease. British Journal of Psychiatry, 157, 7294.
Burns, A., Jacoby, R. & Levy, R. (1991) Neurological signs in Alzheimer's disease. Age and Ageing, 20, 4551.
Cadet, J. L., Rickler, K. C. & Weinberger, D. R. (1986) The clinical examination in schizophrenia. In Handbook of Schizophrenia, Vol. 1: The Neurology of Schizophrenia (eds Nasrallah, H. A. & Weinberger, D. R.), pp. 147. Amsterdam: Elsevier.
Carabellese, C., Appollonio, I., Rozzini, R., et al (1993) Sensory impairment and quality of life in a community elderly population. Journal of the American Geriatric Society, 41, 401407.
Carpenter, W. T., Strauss, J. S. & Bartko, J. J. (1974) The diagnosis and understanding of schizophrenia. I. Use of signs and symptoms for the identification of schizophrenic patients. Schizophrenia Bulletin, 1, 3749.
Castle, D. J. & Murray, R. M. (1991) The neurodevelopmental basis of sex differences in schizophrenia. Psychological Medicine, 21, 565575.
Castle, D. J. & Howard, R. (1992) What do we know about the etiology of late-onset schizophrenia? European Psychiatry, 7, 99108.
Cooper, A. F. (1976) Deafness and psychiatric illness. British Journal of Psychiatry, 129, 216226.
Cooper, A. F., Curry, A. R., Kay, D. W. K., et al (1974) Hearing loss in paranoid and affective psychoses of the elderly. Lancet, ii, 851854.
Cooper, A. F. & Porter, R. (1976) Visual acuity and ocular pathology in the paranoid and affective psychoses of later life. Journal of Psychosomatic Research, 20, 107114.
Corbin, S. L. & Eastwood, M. R. (1986) Sensory deficits and mental disorders of old age: causal or coincidental associations? Psychological Medicine, 16, 251256.
Creer, C. & Wing, J. K. (1975) Living with a schizophrenic patient. British Journal of Hospital Medicine, 14, 7382.
Crow, T. J. (1980) Molecular pathology of schizophrenia: more than one disease process? British Medical Journal, 280, 6668.
Cummings, J. L. (1985) Organic delusions: phenomenology, anatomical correlations, and review. British Journal of Psychiatry, 146, 184197.
Cummings, J. L. (1992) Psychosis in neurologic disease: neurobiology and pathogenesis. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 5, 144150.
Cutting, J. (1987) The phenomenology of acute organic psychosis: comparison with acute schizophrenia. British Journal of Psychiatry, 151, 324332.
David, A. S. & Lucas, P. A. (1992) Neurological models of auditory hallucinations. In Delusions and Hallucinations in Old Age (eds Katona, C. & Levy, R.), pp. 5783. London: Gaskell.
Eastwood, M. R., Corbin, S. & Reed, M. (1981) Hearing impairment and paraphrenia. Journal of Otolaryngology, 10, 306308.
Endicott, J., Nee, J., Fleiss, L., et al (1982) Diagnostic criteria for schizophrenia. Archives of General Psychiatry, 39, 884889.
Fish, F. (1960) Senile schizophrenia. Journal of Mental Science, 106, 938946.
Flint, A. J., Rifat, S. L. & Eastwood, M. R. (1991) Late-onset paranoia: distinct from paraphrenia? International Journal of Geriatric Psychiatry, 6, 103109.
Förstl, H., Burns, A., Levy, R., et al (1992a) Neurologic signs in Alzheimer's disease: results of a prospective clinical and neuropathologic study. Archives of Neurology, 49, 10381042.
Funding, T. (1961) Genetics of paranoid psychoses in later life. Acta Psychiatrica Scandinavica, 37, 267282.
Galasko, D., Kwo-on-Yuen, P. F., Klauber, M. R., et al (1990) Neurobiological findings in Alzheimer's disease and normal aging. Archives of Neurology, 47, 625627.
Goldstein, J. M., Tsuang, M. T. & Faraone, S. V. (1989) Gender and schizophrenia: implications for understanding the heterogeneity of the illness. Psychiatry Research, 28, 243253.
Grahame, P. S. (1984) Schizophrenia in old age Gate paraphrenia). British Journal of Psychiatry, 145, 493495.
Grahame, P. S. (1988) Late paraphrenia [letter]. British Journal of Psychiatry, 152, 289.
Häfner, H., Maurer, K., Löffler, W., et al (1993) The influence of age and sex on the onset and early course of schizophrenia. British Journal of Psychiatry, 162, 8086.
Harrington, M. G. (1991) Physical examination. In Psychiatry in the Elderly (eds Jacoby, R. & Oppenheimer, C.), pp. 199233. Oxford: Oxford University Press.
Harris, A. E., Cullum, C. M. & Jeste, D. V. (1988) Clinical presentation of late-onset schizophrenia. Journal of Clinical Psychiatry, 49, 356360.
Harris, A. E. & Jeste, D. V. (1988) Late onset schizophrenia: an overview. Schizophrenia Bulletin, 14, 3955.
Hécaen, H. & Ropert, R. (1963) Les hallucinations auditives des otopathes. Journal Psicologic Normale et Pathologiques, 60, 293324.
Herbert, M. E. & Jacobson, S. (1967) Late paraphrenia. British Journal of Psychiatry, 113, 461469.
Hogarty, G. E., Goldberg, S. C. & Schooler, N. R. (1974) Drugs and sociotherapy in the aftercare of schizophrenic patients. III. Adjustment of nonrelapsed patients. Archives of General Psychiatry, 31, 609618.
Holden, N. L. (1987) Late paraphrenia or the paraphrenias? A descriptive study with a 10-year follow-up. British Journal of Psychiatry, 150, 635639.
Howard, R., Castle, D., O'Brien, J., et al (1992a) Permeable walls, floors, ceilings and doors: partition delusions in late paraphrenia. International Journal of Geriatric Psychiatry, 7, 719724.
Howard, R., Förstl, H., Almeida, O., et al (1992b) Computer-assisted CT measurements in late paraphrenia with and without Schneiderian first rank symptoms: a preliminary report. International Journal of Geriatric Psychiatry, 7, 3538.
Howard, R., Förstl, H., Naguib, M., et al (1992c) First-rank symptoms of Schneider in late paraphrenia: cortical structural correlates. British Journal of Psychiatry, 160, 108109.
Howard, R., Almeida, O. & Levy, R. (1993a) Schizophrenic symptoms in late paraphrenia. Psychopathology, 26, 95101.
Howard, R., Castle, D., Wessely, S., et al (1993b) A comparative study of 470 cases of early- and late-onset schizophrenia. British Journal of Psychiatry, 163, 352357.
Howard, R., Cluckie, A. & Levy, R. (1993c) Striatal-D2 receptor binding in late paraphrenia. Lancet, 342 (ii), 562.
Howard, R., Almeida, O. P. & Levy, R. (1994) Descriptive phenomenology, demography and diagnosis in late paraphrenia. Psychological Medicine, 24, 397410.
Hunt, A. L., Orrison, W. W., Yeo, R. A., et al (1989) Clinical significance of MRI white matter lesions in the elderly. Neurology, 39, 14701474.
Jeste, D. V. (1993) Late-onset schizophrenia. International Journal of Geriatric Psychiatry, 8, 283285.
J⊘rgensen, P. & Munk-Jorgensen, P. (1985) Paranoid psychosis in the elderly. Acta Psychiatrica Scandinavica, 72, 358363.
Kato, H., Sugawara, Y., Ito, H., et al (1990) White matter lucencies in multi-infarct dementia: a somatosensory evoked potentials and CT-study. Acta Neurologica Scandinavica, 81, 181183.
Kay, D. W. K. (1972) Schizophrenia and schizophrenia-like states in the elderly. British Journal of Hospital Medicine, 8, 369376.
Kay, D. W. K., Beamish, P. & Roth, M. (1964) Old age disorders in Newcastle upon Tyne. I. A study of prevalence. British Journal of Psychiatry, 110, 146158.
Kay, D. W. K., Cooper, A. F., Garside, R. F., et al (1976) The differentiation of paranoid from affective psychoses by patients' premorbid characteristics. British Journal of Psychiatry, 129, 207215.
Kay, D. W. K. & 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, 649686.
Keith, S. J., Regier, D. A. & Rae, D. S. (1991) Schizophrenic disorders. In Psychiatric Disorders in North America. The Epidemiological Catchment Area Study (eds Robins, L. N. & Regier, D. A.), pp. 3352. New York: Free Press.
Kendell, R. E. (1989) Clinical validity. Psychological Medicine, 19, 4555.
Kertesz, A., Polk, M. & Carr, T. (1990) Cognition and white matter changes on magnetic resonance imaging in dementia. Archives of Neurology, 47, 387391.
Keshavan, M. S., David, A. S., Steingard, S., et al (1992) Musical hallucinations: a review and synthesis. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 5, 211223.
Khan, A. M., Clark, T. & Oyebode, F. (1988) Unilateral auditory hallucinations [letter]. British Journal of Psychiatry, 152, 297298.
Kleist, K. (1913) Is involutional paranoia due to an organic-destructive brain process? (partially trans. Förstl, H., Howard, R., Almeida, O. P. & Stadmüller, G. in 1992 from “Die Involutions-paranoia”, Allgemeine Zeitschrift für Psychiatrie , 70, 164). In Delusions and Hallucinations in Old Age (eds Katona, C. & Levy, R.), pp. 165–166. London: Gaskell.
Kraepelin, E. (1913) Dementia Praecox and Paraphrenia (translated R. M. Barclay in 1919 from Psychiatrie, eine Lehrbuchfür Studierende und Ärzte (8th edn), Vol. III, part 2). Edinburgh: Livingstone.
Krull, A. J., Press, G., Dupont, R., et al (1991) Brain imaging in late-onset schizophrenia and related disorders. International Journal of Geriatric Psychiatry, 6, 651658.
Larson, C. A. & Nyman, G. E. (1970) Age of onset in schizophrenia. Human Heredity, 20, 241247.
Leuchter, A. & Spar, J. (1985) The late-onset psychoses. Journal of Nervous and Mental Diseases, 173, 488494.
Levy, R., Naguib, M. & Hymas, N. (1987) Late paraphrenia [letter]. British Journal of Psychiatry, 151, 702.
Lewine, R. J. (1988) Gender and schizophrenia. In Handbook of Schizophrenia, Vol. 3: Nosology, Epidemiology and Genetics of Schizophrenia (eds Tsuang, M. T. & Simpson, J. C.), pp. 379397. Amsterdam: Elsevier.
Liddle, P. F. (1987a) The symptoms of chronic schizophrenia: a re-examination of the positive-negative dichotomy. British Journal of Psychiatry, 151, 145151.
Liddle, P. F. (1987b) Schizophrenic syndromes, cognitive performance and neurological dysfunction. Psychological Medicine, 17, 4957.
Liddle, P. F., Haque, S., Morris, D. L., et al (1993) Dyspraxia and agnosia in schizophrenia. Behavioural Neurology, 6, 4954.
Lohr, J. B. & Bracha, H. S. (1988) Association of psychosis and movement disorders in the elderly. In Psychosis and Depression in the Elderly. The Psychiatric Clinics of North America, Vol. 11 (eds Jeste, D. V. & Zisook, S.), pp. 5181. Philadelphia: W. B. Saunders.
Loranger, A. W. (1984) Sex difference in age at onset of schizophrenia. Archives of General Psychiatry, 41, 157161.
Manschreck, T. C. (1986) Motor abnormalities in schizophrenia. In Handbook of Schizophrenia, Vol. 1: The Neurology of Schizophrenia (eds Nasrallah, H. A. & Weinberger, D. R.), pp. 6596. Amsterdam: Elsevier.
Marneros, A. & Deister, A. (1984) The psychopathology of ‘late schizophrenia’. Psychopathology, 17, 264274.
McGlashan, T. H. & Fenton, W. S. (1992) The positive-negative distinction in schizophrenia: review of natural history validators. Archives of General Psychiatry, 49, 6372.
McGuffin, P., Farmer, A. E. & Yonace, A. H. (1981) HLA antigens and subtypes of schizophrenia. Psychiatry Research, 5, 115122.
Menezes, P. R. (1992) The Outcome of Schizophrenia in São Paulo, Brazil: Preliminary Results of a 2-year Follow-up Study. MSc dissertation in epidemiology. London School of Hygiene and Tropical Medicine, Department of Epidemiology and Population Sciences, University of London.
Merriam, A. E., Hegarty, A. & Miller, A. (1989) A proposed etiology for psychotic symptoms in white matter dementia. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 2, 225228.
Miller, B. L., Benson, D. F., Cummings, J. L., et al (1986) Late-life paraphrenia: an organic delusional syndrome. Journal of Clinical Psychiatry, 47, 204207.
Miller, B. L., Lesser, I. M., Boone, K. B., et al (1991) Brain lesions and cognitive function in late-life psychosis. British Journal of Psychiatry, 158, 7682.
Miller, B. L., Lesser, I. M., Mena, I., et al (1992) Regional cerebral blood flow in late-life-onset psychosis. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 5, 132137.
Moore, N. C. (1981) Is paranoid illness associated with sensory defects in the elderly? Journal of Psychosomatic Research, 25, 6974.
Mortimer, A. M., McKenna, P. J., Lund, C. E., et al (1989) Rating of negative symptoms using the High Royds Evaluation of Negativity (HEN) Scale. British Journal of Psychiatry, 155 (suppl. 7), 8991.
Mundt, C., Kasper, S. & Huerkamp, M. (1989) The diagnostic specificity of negative symptoms and their psychopathological context. British Journal of Psychiatry, 155 (suppl. 7), 3236.
Naguib, M. & Levy, R. (1987) Late paraphrenia: neuropsychological impairment and structural brain abnormalities on computed tomography. International Journal of Geriatric Psychiatry, 2, 8390.
Naguib, M., McGuffin, P., Levy, R., et al (1987) Genetic markers in late paraphrenia: a study of HLA antigens. British Journal of Psychiatry, 150, 124127.
Nelson, H. E. & Willison, J. (1991) National Adult Reading Test (NART) (2nd edn). Windsor: NFER-Nelson.
Norušis, M. J. (1990) SPSS/PC+ 4.0 Statistical Data Analysis. Chicago: SPSS, Inc.
Norušis, M. J. (1992) SPSS/PC+ 5.0 Statistical Data Analysis for Windows. Chicago: SPSS, Inc.
Pearlson, G. & Rabins, P. (1988) The late-onset psychoses: possible risk factors. In Psychosis and Depression in the Elderly. The Psychiatric Clinics of North America, Vol. 11 (eds Jeste, D. V. & Zisook, S.), pp. 1532. Philadelphia: W. B. Saunders.
Pearlson, G., Kreger, L., Rabins, P. V., et al (1989) A chart review study of late-onset and early-onset schizophrenia. American Journal of Psychiatry, 146, 15681574.
Pearlson, G., Tune, L. E., Powers, R. E., et al (1992) MRI and PET studies in late life-onset schizophrenics. In American College of Neuropsychopharmacology Abstracts, pp. 409410. San Juan: American College of Neuropsychopharmacology.
Pitt, B. (1982) Paranoid psychosis in the elderly. In Psychopharmacology of Old Age. British Association for Psychopharmacology Monograph No. 3 (ed. Wheatley, D.), pp. 179187. Oxford: Oxford University Press.
Post, F. (1966) Persistent Persecutory States of the Elderly. Oxford: Pergamon Press.
Psychopharmacology Research Branch, NIMH (1976) Abnormal Involuntary Movement Scale (AIMS). In Assessment Manual for Psychopharmacology, revised (ed. Guy, W.), pp. 534537. Rockville, MD: National Institute of Mental Health.
Quintal, M., Day-Cody, D. & Levy, R. (1991) Late paraphrenia and ICD–10. International Journal of Geriatric Psychiatry, 6, 111116.
Quitkin, F., Rifkin, A. & Klein, D. F. (1976) Neurologic soft signs in schizophrenia and character disorders: organicity in schizophrenia with premorbid asociality and emotionally unstable character disorders. Archives of General Psychiatry, 33, 845853.
Rabins, P., Pauker, S. & Thomas, J. (1984) Can schizophrenia begin after age 44? Comprehensive Psychiatry, 25, 290295.
Rabins, P., Pearlson, G., Jayaram, G., et al (1987) Increased ventricle-to-brain ratio in late-onset schizophrenia. American Journal of Psychiatry, 142, 557559.
Raymond, V., Beaulieu, M., Labrie, F., et al (1978) Potent antidopaminergic activity of estradiol at the pituitary level of prolactin release. Science, 200, 11731175.
Riecher, A., Maurer, K., Löffler, W., et al (1990) Gender differences in age at onset and course of schizophrenic disorders: a contribution to the understanding of the disease? In Search for the Causes of Schizophrenia, Vol. II (eds Häfner, H. & Gattaz, W. F.), pp. 1433. Berlin: Springer-Verlag.
Roth, M. (1955) The natural history of mental disorders in old age. Journal of Mental Science, 101, 281301.
Roth, M. & Morrisey, J. (1952) Problems in the diagnosis and classification of mental disorders in old age. Journal of Mental Science, 98, 6680.
Sartorius, N., Kaelber, C. T., Cooper, J. E., et al (1993) Progress toward achieving a common language in psychiatry: results from the field trial of the clinical guidelines accompanying the WHO Classification of Mental and Behavioral Disorders in ICD–10. Archives of General Psychiatry, 50, 115124.
Schneider, K. (1959) Clinical Psychopathology. New York: Grune & Stratton.
Seeman, M. V. (1982) Gender differences in schizophrenia. Canadian Journal of Psychiatry, 27, 107112.
Seeman, M. V. & Lang, M. (1990) The role of estrogens in schizophrenia gender differences. Schizophrenia Bulletin, 16, 185195.
Silk, K. R. & Tandon, R. (1991) Negative symptom rating scales. In Negative Schizophrenic Symptoms: Pathophysiology and Clinical Implications (eds Greden, J. F. & Tandon, R.), pp. 6177. Washington, DC: American Psychiatric Press.
Simpson, G. M., Lee, J. H., Zoubok, B., et al (1979) A rating scale for tardive dyskinesia. Psychopharmacology (Berlin), 64, 171179.
Smith, J. M., Kucharski, L. T., Eblen, C., et al (1979a) An assessment of tardive dyskinesia in schizophrenic outpatients. Psychopharmacology (Berlin), 64, 99104.
Smith, J. M., Kucharski, L. T., Oswald, W. T., et al (1979b) A systematic investigation of tardive dyskinesia in inpatients. American Journal of Psychiatry, 136, 918922.
Stein, L. M. & Thienhaus, O. J. (1993) Hearing impairment and psychosis. International Psychogeriatrics, 5, 4956.
Walker, E. (1981) Attentional and neuromotor functions of schizophrenics, schizoaffectives and patients with other affective disorders. Archives of General Psychiatry, 38, 13551358.
Weinberger, D. R. (1987) Implications of normal brain development for the pathogenesis of schizophrenia. Archives of General Psychiatry, 44, 660669.
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) Measurement and Classification of Psychiatric Symptoms. An Instruction Manual for the PSE and CATEGO Program. Cambridge: Cambridge University Press.
Wing, J. K. & Sturt, E. (1978) The PSE–CATEGO System Supplementary Manual. London: MRC Social Psychiatric Unit.
Wong, D. F., Wagner, H. N. Jr, Dannals, R. F., et al (1984) Effects of age on dopamine and serotonin receptors measured by positron tomography in the living human brain. Science, 226, 13931396.
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases. Geneva: World Health Organization.
World Health Organization (1992) The ICD–10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization.
World Psychiatric Association (1983) Diagnostic Criteria for Schizophrenic and Affective Psychoses. Washington, DC: American Psychiatric Press.
Zimbardo, P. G., Anderson, S. M. & Kabat, L. G. (1981) Induced hearing deficit generates experimental paranoia. Science, 212, 15291531.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Psychotic States Arising in Late Life (Late Paraphrenia): The Role of Risk Factors

  • Osvaldo P. Almeida (a1), Robert J. Howard (a2), Raymond Levy (a2) and Anthony S. David (a2)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *