Psychotic states arising in late life (late paraphrenia). The role of risk factors.
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.


METHODS
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.


CONCLUSIONS
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.
Almeida
O P
OP
Departamento de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Brazil.
Howard
R J
RJ
Levy
R
R
David
A S
AS
D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001921:Brain / Q000503:physiopathology; D001927:Brain Diseases / Q000150:complications / Q000503:physiopathology; D003865:Major Depressive Disorder / Q000150:complications / Q000523:psychology*; D004409:Dyskinesia, Drug-Induced; D005260:Female; D006311:Hearing Disorders / Q000150:complications; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D011618:Psychotic Disorders / Q000188:drug therapy / Q000209:etiology*; D012307:Risk Factors; D012737:Sex Factors
D014150:Antipsychotic Agents